PRIORITY LEGAL APPLICATION FORM

Today's Date:

First Name: MI: Last Name:

Street Address: Apt. No.:

City: State: Zip code:

Home Phone: Alternate Phone: E-mail:

Best Time To Call: Morning Afternoon Evening

How did you hear about Priority Legal? Friend    Classified    Internet    Radio     Other:

Have you ever been convicted of a felony, convicted of a misdemeanor involving dishonesty or moral turpitude, or convicted in a military court martial? (A conviction will not automatically bar you from employment): Yes          No

If Yes, please explain:

Is it legal for you to work in this country? Yes       No       When are you available to start work? Date:

What hours do you prefer to work? Full Time (Normal Business Hours)      Part-Time       Weekends

In what local areas do you prefer to work?

Are you able to work at locations not accessible by public transportation? Yes      No

Will you work in a non-smoking office? Yes      No      Will you work in a smoking office? Yes      No

Would you consider a position involving relocation, even at your own expense? Yes No
If yes, please list location preferences:

1. 2. 3.

Would you consider a position involving relocation, if reasonable expenses were paid by the employer? Yes No

NOTES: (For Office Use Only)

CONCERNS:

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IN ADDITION TO ATTACHING YOUR RESUME, please list your work experience below. (List most recent job first)

Company Name/Location

Position or Duties

Salary

Dates of Employment

Reason For Leaving

RELEVANT EDUCATION (List Two Highest)

Degree

College/School & Locator

Major

GPA

Scale

List Professional Certifications, Affiliations and/or Licenses (Please indicate State)

Please list the names of three (3) professional references:

Name

Company

Title

Phone

CERTIFICATE OF CANDIDACY

(To Be Completed By All Candidates)

General: I have submitted the attached form to Priority Legal ("PL") for the purposes of obtaining assistance in securing permanent employment. I understand that I will never be charged a fee by PL for this service. I acknowledge that the use of this form and my filling it out does not indicate that any positions are open nor does it obligate PL to further process my application. I certify as to the accuracy of the matters set forth herein and in any resume that I submit to PL and understand that any mis-statement of fact may cause me to lose any employment that was secured for me by PL.
References: I hereby authorize PL and its agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquiries connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me on this form. Furthermore, I authorize PL and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.
Authorization and Release: I hereby certify that the statements contained in this application or other documents submitted and the statements made during any interview process are true and complete to the best of my knowledge, and I understand that material omissions from or false statements made in this application or other documents submitted or occurring during any interview process shall be grounds for denial of employment or discharge. I authorize PL to investigate references provided on all statements contained in this application or any other documents submitted or made during any interview process, and I release all parties from all liability for any damage that may result from furnishing any information to the PL. I also indemnify PL against any liability which might result from making such an investigation. I understand and agree that I will not directly contact any employer(s) regarding any job opportunities made known to me through the services of PL nor will I actively seek employment by any employer made known to me through the services of PL. I understand and agree that, if I am hired, my employment is for no definite period of time. I further understand and agree that, regardless of the date and payment of wages, salary or benefits, my employment, including wages, salary, or benefits may be terminated with or without cause at any time by PL, if I am hired as a temporary or project employee. In addition, I understand that I likewise may terminate my employment with or without cause and with or without notice at any time.

Signed:

Date: