NAME
Name: (First, Middle, Last)

CONTACT INFO
Your Email

Phone

ADDRESS
Street Address

City

State
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code

EMPLOYMENT INFORMATION
Position(s) Applying for

Type of Employment
Full TimePart TimeTemporary
Date Available

Salary Desired

EDUCATIONAL BACKGROUND
Highest Completed Level of Education
Less than high schoolHigh school diploma or equivalentSome college, no degreePostsecondary non-degree awardAssociate’s degreeBachelor’s degreeMaster’s degreeDoctoral or professional degree
If you have received any college degrees please list them along with the name of the institution and date of your graduation.

SKILLS & QUALIFICATIONS
Summarize any training, skills, licenses and/or certificates that may qualify you as being able to preform job-related functions in the position for which you are applying.

WORK EXPERIENCE - Most Recent First
Dates of Employment
to
Company Name

Company Address

Company Phone

Position Held/Title

Describe Duties/Tasks

Reason for Departure

REFERENCES
Name

Business Relationship to You

Phone

Years Known

TERMS AND CONDITIONS
I understand that any falsification or willful omission of fact made in the application or in connection with any background investigation may be sufficient grounds for rejection of this application or, if discovered after an offer of employment, for immediate dismissal.

I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability DKG & Associates, Inc. and its representatives for seeking, gathering, and using such information and all other persons, corporations or organizations for furnishing such information. DKG & Associates, Inc. reserves the right to conduct internet searches in connection with candidates for employment.

I understand that my employment and compensation is "at will" in that I can be terminated with or without cause, and with or without notice, at any time, at the option of DKG & Associates, Inc. or myself, except as otherwise provided by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

I hereby agree to the terms and conditions of this application as stated above.