Unified Affiliates - Job Application

NOTE: Unified Affiliates is an internal employee leasing company which is a wholly owned subsidiary of PickMeUp Services Corp, which consists of various divisions. Each division has an employee management agreement with Unified Affiliates. The employee will be a Unified Affiliates employee assigned to work for one of these divisions.

Applying as potential: Employee Volunteer

A. PERSONAL INFORMATION:

Last Name:

First:

Initial:

Social Sec #:	Date of Birth: (MM/DD/YYYY)	Referred By:
Home Phone #:	Cell Phone #:	Best time to call:

Present Address:	City:	State:	Zip:
Permanent Address:	City:	State:	Zip:

Driver's License #:

State:

Exp Date:

US citizen? Yes No

Employment Desired? Full Time Part Time

Are you related to anyone in our employ? Yes No Name:

Have you ever applied for or been assigned to any PickMeUp Services Corp division with which Unified Affiliates has a management contract? No Yes
If yes, division name?
If yes, please explain:

Have you ever pled "guilty" or "no contest" to being charged with a misdemeanor / felony*? No Yes

*Answering yes to these questions does not constitute an automatic rejection to employment. Date of the offenses, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

B. POSITION DESIRED:

1st choice:

2nd choice:

Start Date:

Salary:

How did you hear about this position?

C. EDUCATION HISTORY:	High School:	# Yrs completed:	Graduate/GED? Yes No

College/University:

Major:

Degree obtained:

GPA:

# Yrs completed:

Graduate? Yes No

Are you currently attending school? Yes No
If yes, where?

What subjects or specialty work have you studied?

D. WORK EXPERIENCE:

Current Employer:	Date Hired:	Date Terminated:	Contact:
Phone#:	Job Title:	Responsibilities:

Prior Employer:	Date Hired:	Date Terminated:	Contact:
Phone#:	Job Title:	Responsibilities:

Prior Employer:	Date Hired:	Date Terminated:	Contact:
Phone#:	Job Title:	Responsibilities:

Prior Employer:	Date Hired:	Date Terminated:	Contact:
Phone#:	Job Title:	Responsibilities:

Can you operate a personal computer? Yes No

List any other business skills you possess:

E. REFERENCES:	List three (3) personal references

Name:	Phone #:	Business:	Years Known:
Name:	Phone #:	Business:	Years Known:
Name:	Phone #:	Business:	Years Known:

F. AUTHORIZATION:

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed by Unified Affiliates, falsified statements on this application, during interviews or made during any time during employment, shall be grounds for dismissal.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, and/or to make any agreement contrary to the foregoing, unless it is in writing and signed by the Chief Executive Officer of PickMeUp Services Corporation.

I authorize investigation of all information concerning my previous employment and any pertinent information they may have, personal or otherwise, including but not limited to a criminal background check. I also release all divisions, affiliates, officers, directors and employees of Unified Affiliates and/or PickMeUp Services Corporation from all liability for any damages that may result from utilization of such information. All information obtained or given will be kept in the strictest of confidence. I also agree to undergo a pre-employment drug screening.

Date:

Applicant Signature*:

*By typing your name in this box, you agree to the terms and conditions listed on this website.
If you are applying for a position that requires any form of State licensure, please provide a copy at the time of hire, i.e. driving records, nursing licenses, etc.

G. RESUME AND COVER LETTER:

Upload Resume:

JOB APPLICATION for Unified Affiliates