APPLICATION FOR EMPLOYMENT

United Group Programs, Inc.
902 Clint Moore Road, Suite 100
Boca Raton, FL 33487
(561) 997-9892
Fax (561) 997-9927
ugp@ugp.com
www.ugpinc.com
 


 

 

  
Name (last name first)
  
Address:
City, State, Zip
Telephone Number:
Social Security No.
Referred by
Employment  Desired

Position

Date You Can Start

Salary Desired

 

Are You Employed?:
Yes No

 

If You Are Currently Employed May We Contact Your Present Employer?
Yes No

 

Have You Ever Applied To This Company Before?
Yes No

 
Name Of School Location Did You Graduate Subjects Studied
High School

Yes No
College

Yes No
Trade, Business or Correspondence School

Yes No

General

 


Subjects of Study/Research Work Or Special Training/Skills

 


(2000 Characters Max.)

US Military Or Naval Service

 
 

Rank


 

Former Employers- Please List Last Four Employers, Starting With Last One First

  Date,Month,Year Name And Address Of Employer Salary Position Reason For Leaving
From
To
From
To
From
To
From
To

 

References

Give Below The Names Of Three Persons Not Related To You Whom You Have Known For At Least One Year

Last Name, First Name, M.I. Address Years Known Phone Number Business
1st Reference
 

2nd Reference
 

3rd Reference
 

Authorization

I Agree
I Certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. 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 that may result from utilization of such information. I also understand and agree that no representative of this company has the authority to enter into any agreements for employment for any specified period of time, or make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. I specifically consent to a drug test and consent to a criminal background check. I also consent to periodic and random criminal background checks and drug testing, and understand the results may be cause for dismissal.


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