Franklin Collection Service, Inc.

POSITION APPLIED FOR

APPLICATION FOR EMPLOYMENT

Applying for: Full Time

Part Time

ANSWER EACH QUESTION FULLY

PLEASE PRINT CLEARLY

AN EQUAL OPPORTUNITY EMPLOYER

Pursuant to the Fair Credit Reporting Act, you are advised that an inquire may be made by Franklin Collection Service, Inc. during the processing of your application for employment, which will furnish pertinent information concerning but not limited to, character, general reputation, personal characteristics, and mode of living. Upon written request, full details as to the nature and scope of the inquiry (if made) will be provided to you. Applicants are required to furnish proof of identity and legal work authorization prior to hire. All information will be kept strictly confidential. This application will remain active for 60 days. You must reapply for further consideration.

General Information
Last name : First name : Middle Name :

Address Street: CityState Zip

Telephone : Social Security Number :

Previous Address (If less than 3 years at present address)                                 How long did you live there?


On what date could you be available to start work?

What transportation will be used to get to work? Own car Friend Relative Other

Have you ever been employed by this company? If yes, when?
List any friends or relatives working for this company:
Have you ever been discharged or asked to resign from a job?        Yes No

If yes, explain
Are you legally qualified to work in the United States?              Yes No
(Proof of citizenship or immigration status will be required upon employment)

If you are under 18 years of age, can you provide required proof        Yes No

of your eligibility to work?
Can you perform the essential functions of the position applied for?                                    Yes No

If no, are there reasonable accommodations that can be made to allow you to perform the
essential functions of the job?

Have you ever been convicted of a felony or a misdemeanor within                                     Yes No

the last seven years?
If yes, please explain:

(A conviction will not necessarily result in the denial of employment)

PERSONAL REFERENCES: (Not former employers or relatives)

Name and Occupation	Address	Phone Number

EDUCATION & EXPERIENCE:

LEVEL	SCHOOL (CITY & STATE)	# YRS COMPLETED	MAJOR SUBJECTS	DEGREE
PREP OR HIGH SCHOOL
COLLEGE OR UNIVERSITY
OTHER SCHOOLING

(OVER)
EMPLOYMENT EXPERIENCE:
(Start with your present or last job. Account for all time.)

1	EMPLOYER :		DATE EMPLOYED		WORK PERFORMED
	ADDRESS :		FROM MO/YR.	TO MO/YR.
	PHONE :	SUPERVISOR :
	JOB TITLE		SALARY		REASON FOR LEAVING
			STARTING	FINAL
2	EMPLOYER :		DATE EMPLOYED		WORK PERFORMED
	ADDRESS :		FROM MO/YR.	TO MO/YR.
	PHONE :	SUPERVISOR :
	JOB TITLE		SALARY		REASON FOR LEAVING
			STARTING	FINAL
3	EMPLOYER :		DATE EMPLOYED		WORK PERFORMED
	ADDRESS :		FROM MO/YR.	TO MO/YR.
	PHONE :	SUPERVISOR :
	JOB TITLE		SALARY		REASON FOR LEAVING
			STARTING	FINAL

List professional, trade, business, or civic activities and offices held.
You may exclude memberships which may reveal sex, race, religion, national origin, age, or disability or other protected status:

In case of emergency contact Name: Relationship : Phone :

I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information is grounds for dismissal in accordance with Franklin Collection Service, Inc. policy. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that if employed by Franklin Collection Service, Inc. the compensation (and so-called “fringe benefits”) I will receive as a Franklin Collection Service, Inc. employee will constitute full satisfaction for any and all services I render to or on behalf of Franklin Collection Service, Inc. in any capacity.

In consideration of my employment, I agree to conform to the rules and regulations of Franklin Collection Service, Inc. and my employment is at will and can be terminated, with or without cause, and with or without notice, at any time, at the option of either Franklin Collection Service, Inc. or myself. I understand that no manager or representative or Franklin Collection Service, Inc. other than the President or Vice-President of Franklin Collection Service, Inc. has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

I understand that Franklin Collection Service, Inc. has a drug and alcohol policy that provides for reemployment testing as well as testing after employment. I understand that consent to and compliance with the policy is a condition of my employment and that continued employment is based on the successful passing of testing under the policy.

I understand that if I am hired at Franklin Collection Service, Inc., I may be privy to sensitive information. Upon hire, I also understand that I may be asked to execute a non-compete agreement.

I hereby warrant that I have read and fully understood the foregoing and seek employment under these conditions of my own free will and I accordance with my own judgment.

Signature of applicant Date