Job Application

To apply for a position with Structured, please fill out this application form.

This application for employment is good for 30 days only.
Consideration for employment after 30 days requires a new application.

Applicant Contact Information
Date*
MM slash DD slash YYYY
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
If under 18 please list birthday
Are you eligible for employment in the United States?*
- Yes
- No
Which position are you applying for?*
Can you travel if required by this position?*
- Yes
- No
Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodations?*
- Yes
- No
Type of employment desired:*
- Full-time
- Part-Time
- Temporary
Date you will be available to start work:*
MM slash DD slash YYYY
Have you ever been previously employed by our organization?*
- Yes
- No
Do you have a valid Driver’s License?*
- Yes
- No
Driver's License Expiration Date:
MM slash DD slash YYYY
How many accidents have you had in the past three years?*
How many moving violations have you had in the last three years?*
References
Please list two professional references other than relatives including, names, telephone numbers, and years known.
Reference 1:*
Reference 1 Email
Reference 1 Phone
Reference 1 Years Known
Reference 2:*
Reference 2 Email
Reference 2 Phone
Reference 2 Years Known
Educational History
List school name and location, number of years completed, course of study, and any degrees earned.
High School:
College:
Technical:
Other:
Employment History
Please provide all employment information for your past four employers starting with the most recent. If you were self-employed, give firm name.
Employer Name:*
Position Held:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:
Immediate supervisor and title:
Name: Title:
Dates employed from:
MM slash DD slash YYYY
Dates employed to:
MM slash DD slash YYYY
Duties:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
May we contact your current employer?
- Yes
- No
Employer Name:*
Position Held:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Immediate supervisor and title:
Name: Title:
Dates employed from:
MM slash DD slash YYYY
Dates employed to:
MM slash DD slash YYYY
Duties:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
May we contact your current employer?
- Yes
- No
Employer Name:*
Position Held:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:
Immediate supervisor and title:
Name: Title:
Dates employed from:
MM slash DD slash YYYY
Dates employed to:
MM slash DD slash YYYY
Duties:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
May we contact your current employer?
- Yes
- No
Employer Name:*
Position Held:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:
Immediate supervisor and title:
Name: Title:
Dates employed from:
MM slash DD slash YYYY
Dates employed to:
MM slash DD slash YYYY
Duties:
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
May we contact your current employer?
- Yes
- No
Other Skills and Qualifications:*
Summarize any job-related training, skills, licenses, certificates, and/or other qualifications.
Please upload your Resume*
Accepted file types: pdf, doc, docx, rtf, txt, Max. file size: 256 MB.
Terms of Service

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information. I may be required to take a test for the presence of drugs or alcohol.

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 specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer 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 this organization 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. I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
- I have read and agree to the Terms of Service
Name
This field is for validation purposes and should be left unchanged.

Applicant Contact Information

References

Educational History

Employment History