Please complete the application, print and mail or fax a copy to:
Pamela J. Maxson
Human Resources Director
Tucker Arensberg, P.C.
1500 One PPG Place
Pittsburgh, PA 15222
fax: 412.594.5619
General Information
Name Date
Present Address Permanent Address
Phone 1 Phone 2
E-mail Address
Please list a phone number where you can be reached during business hours.
Position(s) Applying for: Minimum Salary Requirement:
Can you perform the essential functions of the position for which you are applying? Yes No
Type of Employment Seeking
Full time Part time Temporary Summer
If part time, specify days and hours
Date Available Will you work overtime if asked?
Yes No
Are you a U.S. Citizen?
Yes No
If no, VISA type Number
Are you 18 years of age or older?
Yes No
Have you ever plead guilty to or been convicted of any crime other than a summary offense? Yes No
If yes, please explain
Are any of your relatives employed by Tucker Arensberg, P.C.?
Yes No
Name of relative Relationship to relative
Have you applied for a job with us before? Yes No
Were you ever employed by Tucker Arensberg, P.C.? Yes No
If yes, when?
How were you referred to Tucker Arensberg, P.C.?
Self Newspaper Ad Employment Agency
Law School Recruitment Referred by individual
Web site
Other
Education
High School Location Major Course or Subject
Did you graduate? Degree QPA
Yes No
Business/Technical Location Major Course or Subject
Did you graduate? Degree QPA
Yes No
College/University Location Major Course or Subject
Did you graduate? Degree QPA
Yes No
Graduate/Professional Location Major Course or Subject
Did you graduate? Degree QPA
Yes No
Other Location Major Course or Subject
Did you graduate? Degree QPA
Yes No
List Scholastic Honors
Training
List below any specific training you have had
Skills
Typing wpm
Shorthand wpm
Dictaphone
Switchboard
Personal Computer
MS Windows
MS Office
MS Word
Internet
Mailroom or related equipment
Calculator
Software Used
Employment Record
Starting with your present or most recent employer, list all full-time and part-time employment. Complete this section even if you provide a resume.
Employer Phone
Address City, State, Zip
Salary: Starting Current/Final
Employed:
From (month) (year)
To (month) (year)
Job Titles/Duties
Reason for leaving or seeking other employment
Employer Phone
Address City, State, Zip
Salary: Starting Final
Employed:
From (month) (year)
To (month) (year)
Job Titles/Duties
Reason for leaving or seeking other employment
Employer Phone
Address City, State, Zip
Salary: Starting Final
Employed:
From (month) (year)
To (month) (year)
Job Titles/Duties
Reason for leaving or seeking other employment
Employer Phone
Address City, State, Zip
Salary: Starting Final
Employed:
From (month) (year)
To (month) (year)
Job Titles/Duties
Reason for leaving or seeking other employment
Have you ever been discharged to asked to resign from a position?
Yes No
If yes, please explain.
If presently employed, may we contact that employer for references?
Yes No
References
List three professional or business references (not relatives)
Name and Address Position & Organization
Telephone Number
Name and Address Position & Organization
Telephone Number
Name and Address Position & Organization
Telephone Number
Certification and Agreement
I certify that all information made by me on this application for employment
is true and correct. I understand that false statements or omissions of
facts on this application shall be sufficient cause for dismissal from or
refusal of employment.
I authorize an investigation of any and all
statements contained in the application. I authorize any previous
employers or educational institutions specified by me in this application to
release to Tucker Arensberg, P.C. any and all information regarding my
employment or scholastic standing together with any other information,
personal or otherwise that may or may not be on their records, and I hereby
release such persons or educational institutions from liability for any damage
or injury to me arising out of the release of such information.
I understand that Tucker Arensberg, P.C. does not
guarantees me employments for any specific length of time, regardless of the
quality of my work. I agree, therefore, that my employment for any
specific length of time, regardless of the quality of my work. I agree,
therefore, that my employment may be terminated by me or Tucker Arensberg,
P.C. at any time, with or without cause. I further understand that this
is an application for employment and that no employment is being offered at
this time.
I understand that if I am offered employment, Tucker
Arensberg, P.C. will require me to produce certain documents within three
business days of my hire date in order to comply with the Immigration Reform
and Control Act of 1986. I further understand that any offer of
employment is contingent upon providing the appropriate documents.
If employed as a referral from an employment agency, I hereby agree to reimburse Tucker Arensberg, P.C. an annualized prorated share of the agency fee paid on my behalf in the event I terminate my employment within one year from date of hire. The reimbursement payment would be equal to 1/12th of the original agency fee for each uncompleted month of employment during the first year.
I acknowledge that I have read and understand the above statements.
Applicant's signature Date