The Clinton Group

Position:*
--------- Teleservices Representative Sales/Service Representative Callroom Supervisor

Personal Info

First Name:*

Last Name:*

Middle Initial:*

Social Security Number:*

Address:*

City:*

State:*
--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Zip Code:*

Phone:*

Emergency Phone Number:

How long have you lived at this address? (years)*

Previous Address:

City:

State:
--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Zip Code:

Job Preferences

Type of work preferred?*

Would you accept another position?*
--------- Yes No

Do you have telemarketing experience?*
--------- Yes No

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

Are you willing to work over 40 hours/week?*
--------- Yes No

Are you willing to work nights?*
--------- Yes No

Are you willing to work weekends?*
--------- Yes No

Education

High School

School Name:

City:

State:
--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Years attended:

College

School Name:

City:

State:
--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Major:

Degree Obtained:

Years attended:

Other

School Name:

City:

State:
--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Major:

Degree Obtained:

Years attended:

Work History

Position 1

Company/Organization:*

Phone:*

Job Title:*

City:*

State:*
--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Start Date:*

End Date:*

Reason for leaving:*

Rate of pay:*

Position 2

Company/Organization:

Phone:

Job Title:

City:

State:
--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Start Date:

End Date:

Reason for leaving:

Rate of pay:

Position 3

Company/Organization:

Phone:

Job Title:

City:

State:
--------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming

Start Date:

End Date:

Reason for leaving:

Rate of pay:

Other Info

Are you legally eligible for employment in the U.S.?*
--------- Yes No

Have you ever worked for this company?*
--------- Yes No

Have you ever been convicted of a crime?*
--------- Yes No

If so, please describe:

Military Service

Branch:

Rank at discharge:

Service Start Date:

Service End Date:

MOS/Duties:

Certification

I certify that the information in this application is correct to the best of my knowledge and understand that deliberate falsification is grounds for dismissal in accordance with this company's policy. I authorize the references listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing the same to you. I will acknowledge that if I become employed, I will be free to resign at any time for any reason, and this company similarly retains the right to terminate my employment at will. EOE.

E-mail Address:*

Today's Date:*