Careers - APIC Solutions

General Information

Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Email*

Are you 18 years of age or older?*

Yes
No

Do you have a legal right to work in the United States?*

Yes
No

Can you pass a Background Check?*

Yes
No

Can you pass a Motor Vehicle Record Check?*

Yes
No

Are you willing to travel?*

Yes
No

May we contact your current provider?*

Yes
No

Position Applying For*

Desired Salary*

Work Preference*

Full-Time
Part-Time

When are you able to start?*

Were you referenced by an APIC Employee*

Yes
No

Who referenced you?*

Education

High School - Name of School

High School - # of Years

High School - Diploma or Degree

College - Name of School

College - # of Years

College - Diploma or Degree

Bus. or Trade School - Name of School

Bus. or Trade School - # of Years

Bus. or Trade School - Diploma or Degree

Professional School - Name of School

Professional School - # of Years

Professional School - Diploma or Degree

Industry Certifications or Licenses

Background Data

Are you currently a member of the National Guard?

Yes
No

Have you ever been in the Armed Forces?

Yes
No

Specialty

Date Entered

Date Discharged

Do you have a current valid driver's license?*

Yes
No

Do you have a dependable transportation to and from work*

Yes
No

Driver License number

State of Issue

State

Operator
Commercial (CDL)

Expiration Date

Work Experience

Please list your work experience for the past five years beginning with your most recent job held.

Name of employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name of last supervisor

Your Job Title

Employment Start Date

Employment End Date

Reason for leaving

Name of employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name of last supervisor

Your Job Title

Employment Start Date

Employment End Date

Reason for leaving

Name of employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name of last supervisor

Your Job Title

Employment Start Date

Employment End Date

Reason for leaving

Name of employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name of last supervisor

Your Job Title

Employment Start Date

Employment End Date

Reason for leaving

Name of employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name of last supervisor

Your Job Title

Employment Start Date

Employment End Date

Reason for leaving

References

Please list two references other than relatives or previous employers

Name

Position

Company

Phone

Relationship to Reference

Name

Position

Company

Phone

Relationship to Reference

APIC Solutions Inc. is an Equal Opportunity Employer and it is policy of the company to provide opportunities to all qualified persons without regard to race, religious belief, sex, age, national origin, ancestry, physical or mental handicap, or veteran's status.

I certify that I have accurately answered all questions and have given all information to my full knowledge requested in this application for employment. I understand that any wrong or incomplete information on the form may disqualify me for further consideration for employment or, if discovered after I am hired, may be grounds for my immediate dismissal. I understand that all such information in subject to verification by APIC Solutions Inc., and hereby give my consent to APIC Solutions Inc. to investigate my background and qualifications using any means, sources, and outside investigators at its disposal. I agree to undergo nay type of drug and/or alcohol testing that APIC Solutions Inc. may require at any time. Finally, I understand the submission of this application does not necessarily mean that I will be hired, and that if I am hired, my employment will be at will, and APIC Solutions Inc. may terminate my employment at any time, with or without notice or reason.

Name*

First Last

Signature*

Name

This field is for validation purposes and should be left unchanged.