Middle Name or Initial:
Are you authorized to work lawfully in the United States for MCP?
Will you now or in the future require MCP to commence an immigration case in order to employ you (for example, H-1B or other employment-based immigration case)? This is sometimes called "sponsorship" for an employment-based visa status.
How did you hear about MCP?
When are you available to start a new position?
Have you ever worked for this company?
If yes, please indicate the dates of employment and position held:
Have you ever been convicted of a felony?
If not already located near one of our office locations, would you consider relocation to Pennsylvania, North Carolina, or Texas?
If yes, please check the location of interest:
# Years Attended College:
Did you graduate college?
# Yrs Attended High School:
Did you graduate High School?
Current Employer Address:
Current Employer Phone #:
What is your reasoning for leaving?
May we contact your current supervisor for a reference?
Previous Employer Address:
Previous Employer Phone #:
Previous Employer Supervisor:
Previous Employer Job Title:
Previous Employer Final Salary:
Previous Employer Start Date:
Previous Employer End Date:
What was your reason for leaving Previous Employer?
May we contact Previous Employer Supervisor for a reference?
Reference 1 Current Company:
Reference 1 Email Address:
Relationship with Reference 1:
Reference 2 Current Company:
Reference 2 Email Address:
Relationship with Reference 2:
Reference 3 Current Company:
Reference 3 Email Address:
Relationship with Reference 3:
Reference 4 Current Company:
Reference 4 Email Address:
Relationship with Reference 4:
Offer of Employment with Mission Critical Partners is contingent on acceptable outcomes from a full background check to include criminal, driving, and credit history.
Disclaimer and Electronic Signature:
I understand that, if hired by MCP, my employment would be "at-will" and could be terminated at any time by either party, with or without cause and with or without notice.
I certify my answers are true and complete to the best of my knowledge.
Equal Opportunity Poster - EEO is the Law. Click the following link to view the "EEO is the Law"poster from the EEOC website: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf:
Equal Opportunity and Affirmative Action Employer *
Minorities * Females * Disabled * Protected Veterans:
American Indian or Alaskan Native
Hispanic or Latino
Black or African American
Native Hawaiian or other Pacific Islander
Two or more races
Invitation to Self-Identify as a Veteran
This employer is a Government contractor subject to the Vietnam Era Veterans’
Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002,
38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative
action to employ and advance in employment: (1) disabled veterans; (2) recently
separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed
Forces service medal veterans. These classifications are defined as follows:
A "disabled veteran" is one of the following:
a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or
who but for the receipt of military
retired pay would be entitled to compensation) under laws
administered by the Secretary of Veterans Affairs; or
a person who was discharged or released from active duty because
of a service-connected disability.
A "recently separated veteran" means any veteran during the three-year period
beginning on the date of such veteran’s discharge or release from active duty
in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who
served on active duty in the U.S. military, ground, naval or air service during a
war, or in a campaign or expedition for which a campaign badge has been
authorized under the laws administered by the Department of Defense.
An "Armed forces service medal veteran" means a veteran who, while serving
on active duty in the U.S. military, ground, naval or air service, participated in
a United States military operation for which an Armed Forces service medal
was awarded pursuant to Executive Order 12985.
If you believe you belong to any of the categories of protected veterans listed above, please indicate by
checking the appropriate box below.
As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness
of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.
I IDENTIFY AS ONE OR MORE OF THE CLASSIFICATIONS OF PROTECTED VETERAN LISTED ABOVE
I AM NOT A PROTECTED VETERAN
I DON'T WISH TO ANSWER
OMB Control Number 1250-0005
Voluntary Self-Identification of Disability
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to
qualified people with disabilities. i
To help us measure how well we are doing, we are asking you to tell us if you
have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will
choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used
against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may
become disabled at any time, we are required to ask all of our employees to update their information every five
years. You may voluntarily self-identify as having a disability on this form without fear of any punishment
because you did not identify as having a disability earlier.
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that
substantially limits a major life activity, or if you have a history or record of such an impairment or medical
Disabilities include, but are not limited to:
Multiple sclerosis (MS)
Missing limbs or partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.
Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples
of reasonable accommodation include making a change to the application process or work procedures,
providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
iSection 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal
employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract
Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required
to respond to a collection of information unless such collection displays a valid OMB control number. This
survey should take about 5 minutes to complete.