Application of Employment

The companies of ManhattanLife are Equal Opportunity Employers and do not discriminate on the basis of race, color, sex, religion, age or national origin in any of its hiring or personnel decisions. We comply with the American with Disabilities Act and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential job functions. Hire may be subject to passing a medical examination, and skill and agility tests.

* = Required fields, but complete all possible.

PERSONAL INFORMATION (Please Complete All Information)

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EMERGENCY INFORMATION (Person to be notified in case of emergency)

EDUCATION BACKGROUND

Elementary School

High School

College
 

Trade, Business or Correspondence School
 
 

EMPLOYMENT HISTORY

List below all present and past employment starting with your most recent employer (at least 5 years of past employment is required). Account for all periods of unemployment.
 
 

 

 

 

 

 

 

References






NOTICE TO ALL APPLICANTS: READ BEFORE SIGNING

INITIAL IN THE SPACES PROVIDED BELOW
NOTE: This application will be considered active for 90 days. If you have not been employed within this period and are still interested in employment, please contact the office where you applied and request that our application be reactivated. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, sexual orientation, marital or veteran status, or the presence of a non-job-related medical condition or disability.

RELEASE AUTHORIZATION

APPLICANT COMPLETE THE FOLLOWING
I. In connection with my application for employment, I understand that a consumer report or an investigative consumer report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, you may be requesting information from public and private sources about my: workers' compensation injuries, driving record, court record, education, credentials, credit, and references.
II. Medical and workers' compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a consumer reporting agency. If so, I will be notified and given the name and address of the agency or the source which provided the information.
III. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original. This release is valid for most federal, state and county agencies including the Minnesota Department of Labor.
 Request a Copy
The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release the employer and agents and all persons, agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports.
The following states require sex and race to obtain information: AL, AR, FL, GA, IA,IL, Ml, OR, TX, WI
 Male      Female
 Asian      Black      Hispanic      White      Other

Georgia Bureau of Investigation Georgia Crime Information Center Consent Form

I hereby authorize ADP Screening and Selection Services, Inc. Ft. Collins, CO to receive any Georgia criminal history record information pertaining to me which may be in the files of any state or any local criminal justice agency in Georgia.
 Male      Female
 Asian      Black      Hispanic      White      Other