Application Form If you need assistance in completing the application please let us know so that we can discuss a reasonable accommodation. Step 1 of 7 - Preface 14% Position Applied For* Today's Date* MM slash DD slash YYYY Personal InformationName* First Middle Last Preferred Name or Nickname Email Current Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*How or whom were you referred to DMP?* Have you filed an application with DMP before?* Yes No What Date was your last application?* MM slash DD slash YYYY Are you 18 or older?* Yes No Can you furnish a work permit?* Yes No Are you legally authorized to work in the United States?*(If hired, you will be required to submit proof of your identity and legal work authorization.) Yes No Have you ever been employed by DMP?* Yes No When was the last time you worked for DMP?* MM slash DD slash YYYY Do you have any friends or relatives employed at DMP?* Yes No What are the names of your friends or relatives who work for DMP?* Have you been convicted of a crime in the past 10 years?*Excluding misdemeanors and summary offenses, or anything annulled, expunged, or sealed by a court. Yes No Please describe your conviction(s) in full* Employment InformationDate available to start* MM slash DD slash YYYY Total hours available per week*Are you looking for a full- or part-time position?* Full-time Part-time What hours/shift do you prefer?* Days (1st shift) Evening (2nd shift) Are you looking for a permanent or temporary position?* Permanent Temporary After what date will you be unavailable?* MM slash DD slash YYYY Are you available for work on Saturdays?* Yes No Are you available for work on Sundays?* Yes No Are there any days or hours you are unable or unwilling to work?* Yes No Please explain any days/hours you are unable/unwilling to work*Do you have reliable transportation to/from work?* Yes No Please specify your salary requirements* AN EQUAL OPPORTUNITY/DRUG-FREE EMPLOYER Direct Mail Processors, Inc. is an equal opportunity employer and we do not discriminate against any applicant because of race, color, religion, sex, national origin, age, disability, sexual orientation, marital status, veteran status, or any other legally protected group. EducationHigh SchoolName* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificHighest Grade Completed*1211109Diploma/GED* Yes No CollegeYears in college?*Please enter a number greater than or equal to 0.CollegePlease list all, whether or not a degree was obtained.NameAddressMajorDegreeGPA OtherAcademic honors, awards, or special recognition Extra curricular activities Specialized training Working SkillsCurrent skillsPlease check all applicable General Clerical Switchboard Typing Inventory Clerk Bookkeeping Payroll Cashier General Warehouse Shipping/Receiving Customer Service Secretarial Accounting Computer Operator Mailroom Maintenance Typing Speed (WPM)Please enter a number greater than or equal to 0.Data Entry Key strokes per hour (Alpha)Please enter a number greater than or equal to 0.Data Entry Key strokes per hour (Numeric)Software Used Calculator/10key experience Yes No Other skills, experience, or aptitudesPlease describe anything else that may be helpful in your job. Employment Experience Please complete in full even though you may have a resume. Please start with your present or most recent job. You may include military service assignments and volunteer activities.Employer 1Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor's Name PhoneDutiesHire Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job Title Starting SalaryFinal SalaryReason for Leaving May we contact? Yes No Employer 2Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor's Name PhoneDutiesHire Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job Title Starting SalaryFinal SalaryReason for Leaving May we contact? Yes No Employer 3Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneDutiesHire Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job Title Starting SalaryFinal SalaryReason for Leaving May we contact? Yes No Employer 4Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor's Name PhoneDutiesHire Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Job Title Starting SalaryFinal SalaryReason for Leaving May we contact? Yes No ReferencesAll applicants must provide at least three (3) employment related referencesReferencesNameAddressTelephoneRelationship Please read carefully before signing: The information and statements provided by me in this application are true, correct, and complete. I understand that I will be subject to immediate dismissal or refusal to hire if at any time DMP discovers that I have omitted, misstated, or falsified information on this application or at any time during the hiring process. I authorize DMP to conduct a background inquiry to verify statements and information on this application, other documentation that I have provided, and other areas that may include prior employment, criminal convictions, motor vehicle history, and other relevant reports. I authorize all previous employers or other persons who have knowledge of me, or my records, to release such information to DMP. I understand that all employees of Direct Mail Processors, Inc. are at will. An acceptance of an offer of employment does not create a contractual obligation. If hired, I will be free to resign at any time. Likewise, DMP will have the right to terminate my employment at any time with or without reason or notice. By checking the below box I hereby certify that I have read and agree with the above statements. Your IP address (136.143.176.51) will be collected along with the form information as part of our e-signature process.I hereby certify that...* I have read and agree with the above statements Applicant Name* First Middle Last Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
