Fillable Employment Application (Veteran's Integration Center)

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Employment Application (Veteran's Integration Center)

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The Employment Application (Veteran's Integration Center) form is 3 pages long and contains:

  • 1 signature
  • 1 check-box
  • 125 other fields

Country of origin: US
File type: PDF

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1
Veterans Integration Centers
13140 Central Ave NE, Albuquerque, NM 87123
PH: (505) 296-
0800
Employment Application
The VIC® is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race,
color, religion, sex, national origin, disability status, protected Veteran status, or any other characteristic by law.
Applicant Information
Full Name:
First
M.I. Last
Address:
Street Address
Apartment/Unit #
State
ZIP Code
Phone:
Email
Date Available:
SSN #.:
Desired Salary:
$
Position Applied for:
Willing to travel, work weekends or alternate
work schedules with advance notice?
YES NO
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Have you ever worked for this company?
YES
NO
If yes, when?
Previous Employment (last 5 years)
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Intentionally Left Blank
2
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Company:
Phone:
Address:
Supervisor:
Job Title:
Starting Salary:
$
Ending Salary:
$
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor for a reference?
YES
NO
Education
High School:
City / State:
From:
To:
Did you graduate?
YES
NO
Diploma::
College:
City / State:
From:
To:
Did you graduate?
YES
NO
Degree:
Other:
City / State:
From:
To:
Did you graduate?
YES
NO
Degree:
Professional Degree or License: ____________________________ License #: _________________________
School or Licensing Body: ___________________________________ Expiration Date: ____________________
3
Military Service or Family Preference
Branch:
From:
To:
Rank at Discharge:
Type of Discharge:
If other than Honorable, explain:
(Type of discharge does not preclude you from consideration for the position applied)
If claiming Military Family Preference, please explain relationship to the Servicemember or Veteran: _______________
The NMVIC gives preference to Veterans and/or immediate family members which includes domestic partner, spouse
or widow of a Veteran; OR immediate family member caregiver of a Veteran with proof of status
References
Please list two (2) professional and (1) personal reference.
Full Name:
Relationship:
Company:
Phone:
Address:
Full Name:
Relationship:
Company:
Phone:
Address:
Full Name:
Relationship:
Company:
Phone:
Address:
Referral Source
How did you hear about this position? FACEBOOK LinkedIN NM Workforce Connection
NMVIC Website Center for Nonprofit Excellence Other: __________
If the referral is an employee of the NMVIC, please list their name: _____________________________________
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. If this application leads to my employment,
I understand that false or misleading information in my application or interview may result in my immediate termination.
By signing this application, I authorize the NMVIC, and its employees, to investigate all statements and information
contained herein relating to my background, experience and any other information in this application that will enable the
NMVIC to make a determination of my application for employment with the NMVIC.
I hereby release the NMVIC, and its employees, from liability for any damage that may result from utilization of such
information, and understand that the NMVIC will retain my information for a period of up to two (2) years even if I am not
hired for the position for which I am applying for with this application In Accordance With NMVIC Confidentiality and PII
policy and procedures.
I further understand and agree that this application in no way constitutes any offer of employment, agreement or
contract with the NMVIC, and that no representative of the NMVIC is authorized to make an offer of employment unless
specifically made in writing by an authorized representative of the company.
Signature:
Date:
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Employment Application (Veteran's Integration Center)

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Completed 1 March 2021

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