Equity Internship Application

Application for Internship

Equal access to programs and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resource Department.

Position Applied For*
Referral Source*
If referred by current employee, please specify:*
If other, please specify:*

Contact Information
Applicant Name*

First NameMiddle NameLast NameSuffix
Address*
City*
State*
Zip Code*
Phone Number*
Please enter a valid phone number.
Type of Phone*

Cell PhoneHome Phone
Email
example@example.com

Are you under the age of 18?*

YesNo
If you are under 18 and it is required, can you furnish a work permit?*

YesNo
If you cannot furnish a work permit, please explain.*

Have you ever been employed by Effingham Equity before?*

YesNo
If Yes, give dates and positions:*

Are you legally eligible for employment in the United States? (Proof of identity and employment authorization will be required upon employment.)*

YesNo

Availability
Date available to start work*

MonthDayYear
Date
Type of employment desired:*

Full-timeSeasonal
Will you work overtime?*

YesNo
If seasonal, list day(s) and hour(s) available:

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 later stage to the extent permitted by law.
Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)?*

YesNo

Driver's License Information
Driver's License Number or State ID:*
State Issuing Driver's License
Do you currently possess a Commercial Driver's License (CDL)?*

YesNo
CDL Class*
CDL Endorsement(s) & Restrictions

Employment History

Start with your most recent employer, provide the following information:

Employer 1
Employer Name 1*
Phone Number*
Please enter a valid phone number.
Address*
City*
State*
Zip Code*
Position Held*
Supervisor Name:*
May we contact for reference*

YesNo
Start Date*
01/1919
End Date*
12/1919
Why did you leave?*
Summarize the type of work and job responsibilities:*

Employer 2
Employer Name 2
Phone Number
Please enter a valid phone number.
Address
City
State
Zip Code
Position Held
Supervisor Name:
May we contact for reference

YesNo
Start Date
01/1919
End Date
12/1919
Why did you leave?
Summarize the type of work and job responsibilities:

Employer 3
Employer Name 3
Phone Number
Please enter a valid phone number.
Address
City
State
Zip Code
Position Held
Supervisor Name:
May we contact for reference

YesNo
Start Date
01/1919
End Date
12/1919
Why did you leave?
Summarize the type of work and job responsibilities:

Skills & Qualifications:
Summarize any special training, skills, licenses, and/or certificates that may assist you in performing the position for which you are applying.*

Education & Training

Starting with your most recent school attended, provide the following information.

School 1
Name of School 1*
City and State of School*
Last Year Completed*

1234
Specific Degree Completed*
Field of Study

School 2
Name of School 2
City and State of School
Last Year Completed

1234
Specific Degree Completed
Field of Study

School 3
Name of School 3
City and State of School
Last Year Completed

1234
Specific Degree Completed
Field of Study

List any other Training and Courses

Reference 1
Reference Name 1*

First NameLast Name
Title
Phone Number*
Please enter a valid phone number.
Relationship*
Years Known*

Reference 2

This is not a required field.
Reference Name 2

First NameLast Name
Title
Phone Number
Please enter a valid phone number.
Relationship
Years Known

Reference 3

This is not a required field.
Reference Name 3

First NameLast Name
Title
Phone Number
Please enter a valid phone number.
Relationship
Years Known

Applicant Statement
I certify that all information I have provided in order to apply for and secure work with Effingham Equity is true, complete, and correct. 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 Effingham Equity 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 Effingham Equity 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 Effingham Equity’s CEO.

Effingham Equity 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 basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. Effingham Equity likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. Effingham Equity takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

Applicant Statement
Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act, and all applicable federal, state, and local laws, I hereby authorize and permit Effingham Equity to obtain a consumer report and/or an investigative consumer report which may include the following:
1. My employment records;
2. Records concerning any driving, criminal history, civil record, and drug testing;
3. (For truck drivers only) In accordance with the Federal Motor Carrier Safety Regulations Section 382, 413, information concerning alcohol and controlled substances;
4. Verification of my academic and/or professional credentials and information and/or copies of documents from any military service records.
I understand that an “investigative consumer report” may include information as to my character, general reputation, personal characteristics, and mode of living which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information. I agree that a copy of this authorization has the same effect as an original.

I hereby release and hold harmless any person, firm, entity that discloses matters in accordance with this authorization, as well as Effingham Equity from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information.

I understand and acknowledge that under the provision of the Fair Credit Reporting Act I may request a copy of any consumer report from the consumer reporting agency that compiled the report after I have provided proper identification.

I hereby authorize Effingham Equity to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my employment application. This authorization shall remain in effect over the course of my employment. Reports may be ordered periodically during the course of my employment.

Review and eSign Career Application

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Date*

MonthDayYear
Date
Please verify that you are human*
Applicant Signature*

Clear
Should be Empty:

Application for Internship

Contact Information

Availability

Driver's License Information

Employment History

Employer 1

Employer 2

Employer 3

Skills & Qualifications:

Education & Training

School 1

School 2

School 3

Reference 1

Reference 2

Reference 3

Applicant Statement

Applicant Statement

Review and eSign Career Application