Application for Employment
Active for (1) year

We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any application from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodations to the application and/or interview process should notify a representative of the Novum Human Resources.

 

Complete All Sections of this Inquiry.
Applicant Name:
Position(s) applied for or type of work desired:
Location Applying to
Availability Days/Shifts:
Address (City,State,Zip Code):
Telephone Number:
Social Security Number:
Type of Employment Desired:
(Check all that apply)
Full Time
Part Time
Temporary
Date you will be able to start work:
Do you have any objections to working overtime?
Yes
No
Can you travel overnight if required by this position?
Yes
No
Have you ever been previously employed by Novum?
Yes
No
If you were previously employed, when were you employed?
Can you submit proof of legal employment authorization and identity?
Yes
No
If you are under 18, can you furnish a work permit if it is required?
Yes
No
Have you been convicted of a crime in the last 7 years?
Yes
No
If Yes, please explain:
(A conviction will not automatically bar you from employment)
Driver's License Number.
(If driving is an essential job duty.)
How were you referred to us?
 
Employment History
Please provide all employment information for your past four employers starting with the most recent
Employer 1
Employer:
Position Held:
Address:
Telephone #:
Immediate Supervisor (Name & Title)
Dates Employed
From:: To:
Salary:
Job Summary:
Reason For Leaving
Employer 2
Employer:
Position Held:
Address:
Telephone #:
Immediate Supervisor (Name & Title)
Dates Employed
From:: To:
Salary:
Job Summary:
Reason For Leaving
Employer 3
Employer:
Position Held:
Address:
Telephone #:
Immediate Supervisor (Name & Title)
Dates Employed
From:: To:
Salary:
Job Summary:
Reason For Leaving
Employer 4
Employer:
Position Held:
Address:
Telephone #:
Immediate Supervisor (Name & Title)
Dates Employed
From:: To:
Salary:
Job Summary:
Reason For Leaving:
 
 
Education History:
History 1  
Type of Education:
Name of Institution:
Location (City,State):
Major/ Course of Study:
Years Completed:
Did you Graduate?
Yes
No
Degree Received:
History 2  
Type of Education:
Name of Institution:
Location (City,State):
Major/ Course of Study:
Years Completed:
Did you Graduate?
Yes
No
Degree Received:
History 3  
Type of Education:
Name of Institution:
Location (City,State):
Major/ Course of Study:
Years Completed:
Did you Graduate?
Yes
No
Degree Received:
History 4  
Type of Education:
Name of Institution:
Location (City,State):
Major/ Course of Study:
Years Completed:
Did you Graduate?
Yes
No
Degree Received:
 
Professional References:
Reference 1  
Name
Employer
Address
Phone Number
Years Known
 
Reference 2  
Name
Employer
Address
Phone Number
Years Known
 
Reference 3  
Name
Employer
Address
Phone Number
Years Known
 

I hereby authorize Novum to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, consumer agencies and references. I also hereby release Novum and its representatives from liability for seeking, gathering, and using such information to make employment decisions and as well as other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specific length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or Novum can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

I understand that it is the policy of Novum not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that persons need for a reasonable accommodation as required by the ADA.

I also understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired, or provide verification of application for such documentation. Failure to submit such proof within the required time shall result in immediate termination of employment.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

Check here if you agree to the statement above, then click Submit