Application for Employment

APPLICATION FOR EMPLOYMENT

Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application.

We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, religion, sex, national origin, age, physical or mental disability, genetic information, or any other category protected by applicable federal, state, or local laws.

THIS COMPANY IS AN AT-WILL EMPLOYER. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.

Date*

Name*

First Name

Initial

Last Name

Telephone Number*

Present Address (Please include country)*

Email*

Position Applying For*

Desired Salary/Hourly Rate*

How did you hear about this position?*

Are you at least 18 years of age or older?* Yes No

If you are under the age of 18, can you produce the necessary work certificate at the time of employment?* Yes No

Type of employment desired?* Full-time
Part-time

If part-time, specify hours*

Date on which you can start work if hired*

Have you previously applied for employment with ReminderMedia, American Lifestyle Magzine, or Digital Grapes LLC?* Yes No

If yes, when and where did you apply?*

Are you related to anyone currently employed with ReminderMedia, American Lifestyle Magazine, or Digital Grapes LLC?* Yes No

If yes, what is their name?*

Have you ever been employed by ReminderMedia, American Lifestyle Magazine, or Digital Grapes LLC?* Yes No

If yes, provide your dates of employment, location, and reason for separation from employment.*

Are you legally authorized to work in the United States?* Yes No

Will you, now or in the future, require sponsorship for employment visa status (e.g. H1-B visa status)?* Yes No

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?* Yes No

	INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS All applicants: Do not include convictions that were sealed, eradicated, erased, annulled by a court, or expunged, or convictions that result in referral to a diversion program.
	Have you ever plead guilty or no contest to, or been convicted of any criminal offense other than the applicable exceptions listed above?* Yes No
	Have you ever been arrested for any matters for which you currently are out on bail or on your own recognizance pending trial?* Yes No
	If you answered Yes, to either of the above two questions, please provide the date(s) and explain in accordance with the above instructions so that individual circumstances can be considered.*

EDUCATION
High School (Name and Location)	Did you graduate?
College (Name and location)	Did you graduate?	Degree/Major
Other Education (Name and Location)	Did you graduate?	Degree/Major
Honors Received


	Have you ever been terminated or asked to resign from any job?* Yes No
	Has your employment ever been terminated by mutual agreement?* Yes No
	Have you ever been given the choice to resign rather than be terminated?* Yes No
	If you answered Yes to any of the above three questions, please explain the circumstances for each occasion.*

Employer 1
From* Month Year	To* Month Year	Job Title*
Telephone Number*	Name and Address of Employer*	Duties*
Supervisor's Name*	Supervisor's Title*
May we contact?* Yes No	If no, why not?*
Starting Salary*	Ending Salary*	Reason for Leaving*
Do you have additional work experience?* No Yes

Employer 2
From* Month Year	To* Month Year	Job Title*
Telephone Number*	Name and Address of Employer*	Duties*
Supervisor's Name*	Supervisor's Title*
May we contact?* Yes No	If no, why not?*
Starting Salary*	Ending Salary*	Reason for Leaving*
Do you have additional work experience?* No Yes

APPLICATION FOR EMPLOYMENT

INSTRUCTIONS FOR ANSWERING THE NEXT TWO QUESTIONS

EDUCATION

WORK EXPERIENCE

Employer 1

Employer 2

Employer 3

Employer 4

Employer 5

REFERENCES

RESUME

APPLICANT CERTIFICATION

	APPLICATION FOR EMPLOYMENT Please Answer All Questions. Resumes Are Not A Substitute For A Completed Application. We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, religion, sex, national origin, age, physical or mental disability, genetic information, or any other category protected by applicable federal, state, or local laws. THIS COMPANY IS AN AT-WILL EMPLOYER. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE.
	Date* Month Day Year
	Name* First Name Initial Last Name	Telephone Number*
	Present Address (Please include country)*	Email*
	Position Applying For*	Desired Salary/Hourly Rate*
	How did you hear about this position?*
	Are you at least 18 years of age or older?* Yes No
	If you are under the age of 18, can you produce the necessary work certificate at the time of employment?* Yes No
	Type of employment desired?* Full-time Part-time	If part-time, specify hours*
	Date on which you can start work if hired* Month Day Year
	Have you previously applied for employment with ReminderMedia, American Lifestyle Magzine, or Digital Grapes LLC?* Yes No
	If yes, when and where did you apply?*
	Are you related to anyone currently employed with ReminderMedia, American Lifestyle Magazine, or Digital Grapes LLC?* Yes No
	If yes, what is their name?*
	Have you ever been employed by ReminderMedia, American Lifestyle Magazine, or Digital Grapes LLC?* Yes No
	If yes, provide your dates of employment, location, and reason for separation from employment.*
	Are you legally authorized to work in the United States?* Yes No
	Will you, now or in the future, require sponsorship for employment visa status (e.g. H1-B visa status)?* Yes No
	Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?* Yes No


	If applicable, list below any other names by which you have been known which may be necessary to allow us to confirm your work and educational record. For example, change of name, use of an assumed name, nickname, etc.
	List all special technical skills that you feel qualify you for the job for which you are applying (For example, computer programming/language, software, equipment operation, special tools or machines, etc.)

	WORK EXPERIENCE Please list the names of your present and/or previous employers in chronological order with present or most recent employer first. Account for all periods of time including any period of unemployment. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment.


	Please explain fully all gaps in your employment history in excess of one month.

REFERENCES
Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references.
Name*	Company and Position*	Work Relationship*	Telephone Number*
Name*	Company and Position*	Work Relationship*	Telephone Number*
Please list the names of personal references (not previous employers or relatives) who know you well that we may contact.
Name*	Occupation*	Telephone Number*	# of Years Known*
Name*	Occupation*	Telephone Number*	# of Years Known*

	APPLICANT CERTIFICATION
	I understand that ReminderMedia is a drug-free workplace and has a drug and/or alcohol testing program consistent with applicable federal, state, and local law. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees, pursuant to ReminderMedia's policy and federal, state, and local law, may be subject to urinalysis and/or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company's policies and applicable federal, state, and local law. If employed by ReminderMedia, I understand and agree that ReminderMedia, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, company owned/leased vehicles, and computers) and, in certain circumstances, my personal property. I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statements. I certify that all the information on this application, my resume, or any supporting documents I may present during an interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal. This company is an at-will employer according to the laws of The State of Pennsylvania. This means that regardless of any provision in this application, if hired, the company or I may terminate the employment relationship at any time, for any reason, with or without cause or notice. Nothing in this application or in any document or statement, written or oral, shall limit the right to terminate employment at-will. No officer, employee, or representative of the company is authorized to enter into an agreement- express or implied- with me or any applicant for employment for a specified period of time unless such an agreement is in a written contract signed by the CEO of the company. If hired, I agree to conform to the rules and regulations of the company, and I understand that the company has complete discretion to modify such rules and regulations at any time, except that it will not modify its policy of employment at-will. I authorize ReminderMedia or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms necessary for a background investigation. I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to ReminderMedia or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I herby release from liability ReminderMedia and its representatives for seeking such information and all other persons, corporations, or organizations furnishing such information. If hired by ReminderMedia, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. I also understand ReminderMedia employs only individuals who are legally eligible to work in the United States. THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY. I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND COMPLETE.
	Applicant Signature*	Date* Month Day Year

	RESUME
	Please upload a current copy of your resume*