Application form: General Application

Step 1 of 6 Application

Phone Number *	Order
	Phone Number *	Weight for row 1

Address

Address 1 *

Address 2

City *

State *

ZIP code *

Reemployment

Essential Functions *

Yes

No

Need more information about the job's "essential functions" to respond

Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a alter stage to the extent permitted by law.

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Step 2 of 6 Employment History

Employment History

Address

Country *

Address 1

Address 2

City

State

ZIP code

Dates Employed *

Check "Show End Date" to enter the date of departure. Empty 'End date' values will use the 'Start date' values.

Show End Date

Month

Year

to:

Month

Year

Employment History (Additional)		Order
	Employer Phone Number Address Country Position Starting job title/ending job title. Immediate Supervisor Immediate supervisor and title for most recent position held. Contact Supervisor Supervisor Phone Number Supervisor Email Dates Employed Check "Show End Date" to enter the date of departure. Empty 'End date' values will use the 'Start date' values. Show End Date Month Year to: Month Year Other Compensation Please describe any other compensation including, but not limited to, commission or bonus. Reason for Leaving - Select One Reason for Leaving If you chose "other," please explain. Duties and Responsibilites	Weight for row 1
	Employer Phone Number Address Country Position Starting job title/ending job title. Immediate Supervisor Immediate supervisor and title for most recent position held. Contact Supervisor Supervisor Phone Number Supervisor Email Dates Employed Check "Show End Date" to enter the date of departure. Empty 'End date' values will use the 'Start date' values. Show End Date Month Year to: Month Year Other Compensation Please describe any other compensation including, but not limited to, commission or bonus. Reason for Leaving - Select One Reason for Leaving If you chose "other," please explain. Duties and Responsibilites	Weight for row 2

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Step 3 of 6 Qualifications

Computer Skills

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Step 4 of 6 Résumé, cover letter and other supporting documents.

You may type or attach a cover and may upload up to 3 documents.

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Step 5 of 6 Requirements

Physical Requirements

Can you fulfill the following physical requirements?

Availability

Please answer the following questions regarding your availability.

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Step 6 of 6 Applicant Statement

Accept *

By checking "accept" you are signifying your acceptance of the information included in the application, as well as accepting this as your electronic signature.

I certify that all information that I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the bases of his or her sex, race, color, religion, national origin, citizenship, age, disability or any other protected status under applicable federal, state, or local laws. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability or any other protected status. The Company takes all complains of harassment seriously and all complaints will be investigated promptly and thoroughly.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

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PolyScience