yTen Business Solutions

Employment Application

[yTen Business Solutions, Inc.] (the "Company") is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, nation origin, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

Personal

Last Name:		First Name:		Middle Initial:
Address:
City:		State:	Zip:
Phone:		Email:
Referred By:		Wage Desired:
Languages Fluent In:
Are you at least 18 years old? Yes No If under 18, do you have a work permit? Yes No

Positions Applied For: (check all that apply)		Staff Writer Business Development / Vendor Coordinator Spanish Bilingual Customer Service Representative — Inbound Call Center French Bilingual Customer Service Representative — Inbound Call Center Japanese Bilingual Customer Service Representative — Inbound Call Center Portuguese Bilingual Customer Service Representative — Inbound Call Center

Education

High School:	Highest Grade Completed: 9 10 11 12	School:

College, Vocational or Business:	Highest Grade Completed: 1 2 3 4	School:

Graduate Studies:		School:

Do you type? Yes No If yes, how many words per minute?
Computer Skills (Hardware/Software/Graphics):

Employment History

List last three jobs, starting with the most recent position.

Employer Name: Supervisor Name:

Employer Address: Supervisor Phone:

Employed From: Starting Salary:

Employed Until: Ending Salary:

Job Title: Reason for Leaving:

Duties & Responsibilities:

Employer Name: Supervisor Name:

Employer Address: Supervisor Phone:

Employed From: Starting Salary:

Employed Until: Ending Salary:

Job Title: Reason for Leaving:

Duties & Responsibilities:

Employer Name: Supervisor Name:

Employer Address: Supervisor Phone:

Employed From: Starting Salary:

Employed Until: Ending Salary:

Job Title: Reason for Leaving:

Duties & Responsibilities:

General

Yes No		May we contact your current employer for references?

Yes No		If hired, will you be able to work overtime?

Yes No		Will you be able to perform the essential job functions for the position you are applying for with or without reasonable accommodation?

Yes No		Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by court? (A 'yes' response does not automatically disqualify your application.)

Comments

Certification & Authorization

The above information is true and correct. I understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information that I have given in this application is false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery.

I authorize the Company to inquire into my educational, professional and past employment history references as needed to research my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the Company and will hold the Company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit and consumer check.

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with the Company is intended to create an employment contract between myself and the Company under which my employment could be terminated only for cause. On the contrary I understand and agree that, if hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.

If employed, I will be required to provide original documents which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form I-9.

I hereby acknowledge that I have read and agree to the above statements.

Type your name and date: Date:

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