UBR Customer Service Representative Job Application

Application for Employment

Universal Belting Resource is committed to attracting and retaining a diverse workforce that represents the diversity of the communities in which we operate, of our clients, and of their constituents. To support our commitment, we have implemented business policies, a policy of equal employment opportunity, and human resources practices designed to ensure full realization of employment opportunity without regard to race, color, age, religion, sex, national origin, citizenship, disability, sexual orientation, marital status, veteran status and pregnancy or other characteristics to the extent protected by Federal, state or local law. Decisions about recruitment, hiring, training, promotions, compensation benefits, and other human resources practices will be based on individual merit. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Personal Information

Thank you for providing your current personal information. Please note, failure to properly complete these fields may result in a delay or disqualification of your application being considered.

Full Name *

Contact Phone Number *

Email *

Can We Text You? *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

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How Did You Hear About Us?

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Position Information

Please let us know your availability and preferences

Provide The Date You Are Able To Start Work. *

Are You Able To Work Overtime? *

Are You Under 18, And If It Is Required, Can You Furnish A Work Permit? *

Are You Able To Meet The Attendance Requirements Of The Position(s)? *

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Work History

Please provide information on your past work experience. **You can attach your Resume at the end of this application**

Have You Ever Been Employed By UBR Before? If yes, please include your job title and dates of employment. *

Are You Legally Eligible For Employment In This Country? *

Are There Any Other Names Under Which You Have Been Employed? If so, please provide the other names. *

Are You Physically Able To Perform The Duties Of The Position For Which You Applied? If no, please explain: *

Summarize Any Training, Skills, Licenses And/Or Certificates That May Qualify You As Being Able To Perform Job-Related Functions In The Position For Which You Are Applying: *

Employer #1

Please provide the information below on your current or most recent employer

Employer #1 – Company Name *

Employer #1 – Can We Contact This Employer? *

Employer #1 – Company Address, Street, City, State, Zip *

Employer #1 – Phone Number *

Employer #1 – Your Job Title *

Employer #1 – Dates Of Employment, Start Date And End Date *

Employer #1 – What Did You Do At This Employment? *

Employer #1 – Starting And Final Pay *

Employer #1 – Reason For Leaving *

Employer #2

Please provide the information below on your 2nd most recent employer

Employer #2 – Company Name *

Employer #2 – Can We Contact This Employer? *

Employer #2 – Company Address, Street, City, State, Zip *

Employer #2 – Phone Number *

Employer #2 – Your Job Title *

Employer #2 – Dates Of Employment, Start Date And End Date *

Employer #2 – What Did You Do At This Employment? *

Employer #2 – Starting And Final Pay *

Employer #2 – Reason For Leaving *

Employer #3

Please provide the information below on your 3rd most recent employer

Employer #3 – Company Name

Employer #3 – Can We Contact This Employer?

Employer #3 – Company Address, Street, City, State, Zip

Employer #3 – Phone Number

Employer #3 – Your Job Title

Employer #3 – Dates Of Employment, Start Date And End Date

Employer #3 – What Did You Do At This Employment?

Employer #3 – Starting And Final Pay

Employer #3 – Reason For Leaving

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Education and Certifications

High School – Name – Location – Number Of Years Completed *

College – Name – Location – Number Of Years Completed

Other – any other schooling or training or certifications

Reference 1 – please provide their name, how you know them and a contact number *

Reference 2 – please provide their name, how you know them and a contact number *

Reference 3 – please provide their name, how you know them and a contact number *

Application Statement – I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application, or immediately discharge me from the employer’s service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. I understand that this application remains current for only ninety (90) days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by an authorized company officer. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete Form I-9 in this regard. By typing your name and date below you certify that you have read and understand and accept all terms of the foregoing Applicant Statement. *

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