EQUAL OPPORTUNITY EMPLOYER. It is our policy to abide by all federal, state and local laws prohibiting employment discrimination based on a person's race, color, religious creed, sex, national origin, ancestry, citizenship status, pregnancy, childbirth, physical disability, mental and/or intellectual disability, age, military status, veteran status (including protected veterans), marital status, registered domestic partner or civil union status, familial status, gender (including sex stereotyping and gender identity or expression), medical condition (including, but not limited to, cancer related or HIV/AIDS related), genetic information, sexual orientation, or any other protected status.How did you hear about the position for which you are applying?*Name* First Middle Last Current Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code How long at current address?*Daytime Telephone*Email Address* Position for which you are applying*Date available for work* MM slash DD slash YYYY What is your minimum salary requirement?*Are you subject to any type of agreement with a current or former employer or entity that would restrict your ability to work at The Miller Group (e.g., non-compete, non-solicitation)?* Yes No If Yes, explain and provide a copy of such agreement.Are you able to lift more than 50 lbs?* Yes No Education & TrainingHigh SchoolSchool NameCity and StateDegree/Diploma & Major Course of StudyDegree Received Yes No CollegeSchool NameCity and StateDegree/Diploma & Major Course of StudyDegree Received Yes No Graduate SchoolSchool NameCity and StateDegree/Diploma & Major Course of StudyDegree Received Yes No Trade SchoolSchool NameCity and StateDegree/Diploma & Major Course of StudyDegree Received Yes No * Only list colleges or universities accredited by the Department of Education (DOE). The DOE maintains a database of accredited institutions at http://ope.ed.gov/accreditation. It is your responsibility to verify accreditation.List coursework undertaken or degree/diploma received from an unaccredited college, as well as any other education, training, special skills or certificates/licenses that you possess related to the job.Professional License/Certification #Issuing AgencyProfessional License/Certification #Issuing AgencyList any machines, equipment or software programs on which you are qualified and experienced in operating.If you are applying for a position which involves driving a motor vehicle in the course and scope of the employment duties, please indicate whether you have a valid driver's license in this state Yes No Can you, after employment, submit verification of your legal right to work in the United States?* Yes No Are you 18 years old or over?* Yes No Within the past 7 years, have you been employed, or are you currently employed by The Miller Group?* Yes No If Yes, give dates:From (month/year)To (month/year)Do you have any relatives currently working at The Miller Group?* Yes No If Yes, please list the relatives:*Employment History(List all work experience beginning with the present or most recent job. The Miller Group will contact all previous employers to verify your employment. Please list your current or most recent employer first and indicate whether your are currently employed in the spaces provided. The Miller Group will not contact your current employer without permission. You may also include any volunteer and/or military work.)Current/Most Recent JobName of Employer*Type of Business*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Title*Type of Employment* Part-Time Full-Time Supervisor Name*Supervisor Phone Number*May We Contact? Yes No Employed From (month/year)*Employed To (month/year)*Last Salary*Brief Description of Duties*Reason for Leaving*Previous EmploymentName of Employer*Type of Business*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Title*Type of Employment* Part-Time Full-Time Supervisor Name*Supervisor Phone Number*May We Contact? Yes No Employed From (month/year)*Employed To (month/year)*Last Salary*Brief Description of Duties*Reason for Leaving*Previous EmploymentName of EmployerType of BusinessAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code TitleType of Employment Part-Time Full-Time Supervisor NameSupervisor Phone NumberMay We Contact? Yes No Employed From (month/year)Employed To (month/year)Last SalaryBrief Description of DutiesReason for LeavingBusiness References(List three individuals, in addition to listed employment references, known to you for at least three years)1. Name*Occupation/Association*Telephone*Email Address* 2. Name*Occupation/Association*Telephone*Email Address* 3. Name*Occupation/Association*Telephone*Email Address* Please include any other information you think would be helpful to us in considering you for employment, such as additional work experiences, articles/books published, activities, honors received, etc. You may omit all information that would indicate age, sex, sexual orientation, race, religion, color, national origin or disability or any other protected class.Additional InformationResume Upload:*Accepted file types: doc, docx, pdf, Max. file size: 50 MB.Agreement (Please read the following statement carefully)I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsification or significant omission of information requested in this application or in the application process may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize all persons listed above (and on the accompanying resume, if any) to give The Miller Group any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and The Miller Group, from liability for any damage that may result from furnishing same to The Miller Group. If employed by The Miller Group and its client company I agree to abide by the policies and procedures of The Miller Group and its client company, which include the The Miller Group Anti-Harassment Policy. I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of The Miller Group, the client company or myself. I further understand that no manager or representative of The Miller Group or its client company other than the president of The Miller Group has any authority to enter into any agreement, oral or written, on behalf of The Miller Group for a term of employment or to make any assurance or promise of continued employment. DRUG TESTING: I understand and agree that, subject to applicable law, I may be required to take a drug and alcohol screening test. I also understand that if I test positive for the presence of drugs or alcohol. I will be ineligible for employment with the company.Sign and Date the FormApplicant's Signature*Last 4 Digits of Social Security No. 87709
