Simple Job Application Form

Bell Performance, Inc. - Application For Employment
This employer is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, genetic information, disability, veteran status, sexual orientation/gender identity, citizenship status, marital status or any other status protected by law. We assure you that your opportunity for employment with this employer depends solely upon your qualifications.

Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on the company. Please inform the company's human resources representative if you need assistance completing any forms or to otherwise participate in the application process. Please answer all questions completely. Resumes are not accepted in lieu of complete of this application.

NOTE: This application was designed for use with several types of job positions. Some questions may not be completely applicable to the job position you are seeking; however, we ask that you answer all questions. Thank you for your interest in Bell Performance.
I. PERSONAL INFORMATION
Today's Date*

MonthDayYear
Full Name*

First NameMiddle NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email Address*
Home Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Have you ever been involutarily terminated or requested to resign?*

Yes (explain below)No
If yes, please explain
If hired, can you provide verification of your legal right to work in the United States?*

YesNo
Are you at least 18 years of age?*

YesNo
If required for the position, do you have a valid driver's license?*

YesNo
Have you ever worked under a different name?*

Yes (provide name below)No
If yes, what name?
Are you able to perform the essential functions of the position as listed as described on the posted job description or as demonstrated by the company representative with or without a reasonable accommodation?*

YesNo
Do you have a non-compete agreement or are you subject to any restrictive covenant with any of your former employers?*

Yes (please explain below)No
If yes, please explain
II. EMPLOYMENT INTERESTS
Position Desired*
Date Available*

MonthDayYear
Salary Desired*
Would you be willing to work overtime?*

YesNo
Type of Employment Desired*

RegularTemporaryFull-TimePart-Time
Days and hours available for work*
How were you referred to our company?*

Agency (give name below)Ad (give location below)Other (please specify below)Employee referral (give name below)Walk-in
Additional referral details (name, location, etc.)
III. EDUCATION INFORMATION
HIGH SCHOOL
High School Name and Location*
Course of Study*
Last Grade Completed*

1234
Did you graduate?*

YesNo
Degree or diploma
COLLEGE/UNIVERSITY
College/University Name and Location
Course of Study
Last Grade Completed

1234
Did you graduate?

YesNo
Degree or diploma
POST GRADUATE
Post Graduate School Name and Location
Course of Study
Last Grade Completed

1234
Did you graduate?

YesNo
Degree or diploma
BUSINESS/TRADE TECHNICAL SCHOOL
Business/Trade Technical School Name and Location
Course of Study
Last Grade Completed

1234
Did you graduate?

YesNo
Degree or diploma
IV. SKILLS - If Applicable for Position for Which You Are Applying
Foreign Languages
PC Skills
Other Skills
Do you have any experience, training, qualifications or special skills that you think make you especially suited for work at this company?
V. EMPLOYMENT INFORMATION
Start with current or most-recent employer. Account for all time periods including unemployment, self-employment and military service.
COMPANY #1
Company Name*
Your most recent employment
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Phone Number*

Area CodePhone Number
Job Title*
Supervisor Name*
Duties*
Start Date*

MonthDayYear
Finish Date (if applicable)

MonthDayYear
Check if still employed at this company

Still employed
Reason For Leaving
Starting Pay*
Ending Pay*
COMPANY #2
Company Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Phone Number

Area CodePhone Number
Job Title
Supervisor Name
Duties
Start Date

MonthDayYear
Finish Date

MonthDayYear
Reason For Leaving
Starting Pay
Ending Pay
COMPANY #3
Company Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Phone Number

Area CodePhone Number
Job Title
Supervisor Name
Duties
Start Date

MonthDayYear
Finish Date

MonthDayYear
Reason For Leaving
Starting Pay
Ending Pay
COMPANY #4
Company Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Phone Number

Area CodePhone Number
Job title
Supervisor Name
Duties
Start Date

MonthDayYear
Finish Date

MonthDayYear
Reason For Leaving
Starting Pay
Ending Pay
VI. ACKNOWLEDGEMENT
Have you ever been convicted of a crime, pled no contest, had adjudication withheld, or been a defendant in a civil action for an intentional tort?*

Yes (explain below)No
If yes, please list offense, date and disposition of the case
Please read carefully and initial each paragraph to indicate acknowledgement. Finish your application by signing below by entering your full name (first, middle, last) in ALL CAPS.
I understand that as a condition of employment I may be required to take a post-offer/pre-employment alcohol/drug test. I further understand that, if management suspects that I am under the influence of drugs or alcohol, I may be required to take a drug/alcohol test. I also understand that I may be required to submit to a random drug/alcohol test during the course of employment.*
I understand that all offers of employment are conditioned upon my providing satisfactory documentary proof of my identity and legal right to work in the United States.*
This application will remain active for ninety (90) days. Any applicant wishing to be considered for employment beyond ninety (90) days must reapply.*
I hereby acknowledge that I have read the above statements and understand them. I certify that I, the undersigned applicant, have personally completed this application. I declare that the facts contained in the application (or any resume or other documents submitted) are true and complete to the best of my knowledge. I understand that any misrepresentations or omissions will disqualify me from further consideration for employment, and will result in my dismissal from employment, if discovered at a later date.*
PRIVACY STATEMENT

Once Bell Performance receives your application your information will be used only for the purpose of employment. Your information will only be viewed by our management team and stored securely. We will not share any information you provide including your email address with any third parties unless instructed to do so by Federal, State or Local authorities. This application is a web-filled document, when you select the "Submit" button you will receive notification your application has been submitted. Bell Performance does not accept any responsibility for misdirected, lost or intercepted emails of information or the transfer of any viruses, Trojans or complications associated during electronic communications. By completing the application and submitting via email you agree to this policy. You may fill in your information, print and mail your application to Bell Performance, Attn: Human Resources, 1340 Bennett Drive, Longwood, FL 32750.
VII. APPLICANT ELECTRONIC SIGNATURE
Fill in your full name (first, middle, last) in ALL CAPS to sign as your electronic signature for this application. *
Date*

MonthDayYear
By placing a check in the box you agree that all statements you provided are true and any falsifying information could result in termination if employed.*

I acknowledge that all statements I provide here are true and any falsifying information could result in termination if employed.
Upload Resume Here

Upload a File

Cancelof
Should be Empty:

Bell Performance, Inc. - Application For Employment

I. PERSONAL INFORMATION

II. EMPLOYMENT INTERESTS

III. EDUCATION INFORMATION

HIGH SCHOOL

COLLEGE/UNIVERSITY

POST GRADUATE

BUSINESS/TRADE TECHNICAL SCHOOL

IV. SKILLS - If Applicable for Position for Which You Are Applying

V. EMPLOYMENT INFORMATION

COMPANY #1

COMPANY #2

COMPANY #3

COMPANY #4

VI. ACKNOWLEDGEMENT

VII. APPLICANT ELECTRONIC SIGNATURE