USA, Inc. Online Employment Pre-Application

Please complete the following Pre-Employment Questionnaire if you would like to be considered for any of the positions currently available at Unibased Systems Architecture, Inc.  Once your application has been received and reviewed you will be notified as to the next step in the process.  Click here to see current openings!

Today's Date:

Personal Information

Name (Last Name First):
 Social Security Number:
Present Address:
City
 State          Zipcode
     
Permanent Address:
City
 State        Zipcode
 
Phone Number
 Referred By:

Employment Desired

Position:
 Date You Can Start
 Salary Desired
Are You Employed?
Yes  No		 If so, may we inquire of your present employer?
Yes    No
Ever applied to this company before? Yes   No Where?                                        When?
  

Education

Highest Grade Level Attained 12    16     other:

Name and Location of  College/University
 Date Graduated
Degree/Field
 Performance Awards
Yes No
Name and Location of  College/University
 Date Graduated
Degree/Field
 Performance Awards
Yes No
Name and Location of  College/University
 Date Graduated
Degree/Field
 Performance Awards
Yes No
Trade, Business or Correspondence School
 Date Graduated
Degree/Field
 Performance Awards
Yes No

General

Subject of Special Study/Research Work or Special Training/Skills
U.S. Military or Naval Service                            Rank
         

Current or Most Recent Employer

Start Date/End/Date

 Name and Address of Employer

Current (Or Most Recent) Annual Salary

 Position/Title

Reason For Leaving (If Applicable)

Primary Reasons for applying to USA, Inc.

Professional Reference

Name
 Address
Phone
 Years Known
Personal Reference
Name
 Address
Phone
 Years Known

Authorization:

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal.

If you are in agreement with the above statement select yes.
Yes No

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and shall release the company from all liability for any damage that may result from utilization of such information.

If you are in agreement with the above statement select yes.
Yes No

I also understand and agree that no representative of the company 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 unless it is in writing and signed by an authorized company representative.

If you are in agreement with the above statement select yes.
Yes No


Notification: What is the best method of contacting you?

Email  

E-mail Address

Phone

Telephone Number
Mail

Mailing Address

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