FHG, Inc. Employment Application, Part 1 of 2

FHG, Inc. Employment Application, Part 1 of 2
Last Name: ____________________ First Name: ____________________ Middle Name: ____________________
Street Address: _____________________________ City: ____________________ State: ______ ZIP: __________
Mobile Phone: _____________ Home Phone: ____________ Other: _____________ Email: __________________
Date of Birth: ______________ Last Four of SSN: XXXX-XX-______ Date of Application: _________________
How did you learn about us? □ Advertisement
□ FHG employee
□ Other _______________________________
Position(s) applying for: ___________________________________________________________________________
Are you legally eligible to work in the United States?
□ Yes □ No
Have you ever filed an application with or been employed by FHG, Inc. before?
□ Yes □ No
Are you related to anyone employed by FHG, Inc?
□ Yes □ No
If yes, please provide date(s): ________________________________________
If yes, please provide name and relationship: _____________________________
Date Available to Start: _____________ Desired Status: □ Full-time □ Part-time □ Temporary □ Internship
Our field positions require 100% travel. Is this a problem?
□ Yes □ No
Do you have a valid driver’s license?
□ Yes □ No
Have you ever been convicted of a felony or a DUI/DWI?
□ Yes □ No
If yes, please explain (a conviction will not necessarily disqualify you): __________________________________
____________________________________________________________________________________________
Have you ever been fired from or asked to resign from a job?
□ Yes □ No
If yes, please explain (answering yes will not necessarily disqualify you): ________________________________
____________________________________________________________________________________________
Have you ever tested positive, or refused to test, on any drug or alcohol test?
□ Yes □ No
Describe any specialized and relevant skills, training, licenses, apprenticeships or computer skills you have:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Please provide information on your 3 most recent employers.
Employer 1: _________________ City/State: __________________ Work Performed: _________________________
Employer 21: _________________ City/State: __________________ Work Performed: _________________________
2
Employer 31: _________________ City/State: __________________ Work Performed: _________________________
Please provide 2 references, at least one of whom is a manager from a previous job.
Reference 1 Name: ______________ Relationship: ______________Phone: ___________ Email: ________________
Reference 2 Name: ______________ Relationship: ______________Phone: ___________ Email: ________________
FHG, Inc. is an equal-opportunity employer and considers applicants for all positions without regard to race, color, religion,
creed, gender, national origin, age, sexual orientation, disability, marital or veteran status, or any other status protected
under local, state or federal laws.
□ By checking this box, you verify that all of the information provided in this application is correct, accurate and complete to the best of
your knowledge and acknowledge that submission of an application does not guarantee employment.
To be considered for employment, this completed Employment Application, Part 1 must be submitted to [email protected].

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