Vesta, Inc.
10123 Senate DriveLanham, MD 20706
(301) 459-9840 Fax: (240) 539-6004
APPLICATION FOR EMPLOYMENT
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| Vesta, Inc., an equal opportunity employer, does not discriminate on the basis of gender, age, race, creed, color, national origin, ancestry, marital status, sexual orientation, or disability. Vesta, Inc. actively promotes a drugfree workplace and a smoke-free environment. |
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| Resumes may be attached to but not substituted for a completed application. Incomplete applications will not be processed. If hired, you will be required to provide proof of legal right to work in the U.S. Prior to and throughout your employment tenure, you are required to follow Vesta’s regulations for drug screening and TB Screening, as well as compliance with training and personnel requirements. |
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Date:
Preferred Position:
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Preferred Location:
Preferred Shift Hours:
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Last Name:
First Name:
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MI:
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Current Residence Street Address:
Since:
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City:
County:
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State:
Zip:
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Email Address:
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Are you 18 years of age or older?
Yes
No |
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Home/Cell Phone:
Other Contact Phone:
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| This position may require that you use your personal vehicle. As part of your employment, Vesta, Inc. will obtain your Motor Vehicle records from states of residence for the past 3 years. If you have 3 or more points on your record, you will be disqualified. If you are disqualified from driving, your employment may be terminated. You are also required to present a copy of your auto insurance policy at the time of hire. |
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License Number:
State Issued:
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Driving Restrictions
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Have you ever been convicted of any criminal, alcohol/drug related, or motor vehicle offense? A conviction
does not necessarily disqualify your application.
Yes
No |
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If Yes, explain:
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Do you have any relatives by blood or marriage working for Vesta?
Yes
No |
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If Yes, name and relationship:
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Were you previously employed by Vesta, Inc.?
Yes
No |
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From:
To:
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How did you learn about this position and Vesta, Inc?
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Current/Past Employee of Vesta, Inc. Please provide Name, Postion and Region.
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Newspaper Advertising:
Washington Post
Baltimore Sun
Regional or local newspaper
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Employment Publications:
Employment Today
Employment Guide
Employment News
Penny Saver
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Internet:
Vesta Websit
Other Job Website |
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Radio Advertising:
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EDUCATION |
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1. School/College:
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Degree/Date Of Graduation:
Major:
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2. School/College:
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Degree/Date of Graduation:
Major:
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3. School/College:
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Degree/Date of Graduation:
Major:
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Internship:
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Supervisor/Dean:
Phone #:
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Professional Certification/Licensure:
Certificate/License #:
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Last CPR expiration Date:
Last First Aid Certification Date:
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Sign Language:
Yes
No
Languages Known Other Than English:
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EMPLOYMENT HISTORY
Begin with your most recent or current position. Do not omit any employment. |
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1. Name and address of employer:
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From:
To:
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Immediate Supervisor:
Phone #:
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Position:
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Starting Salary:
Ending Salary:
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Please describe job duties:
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Reason for Separation/Desire to change:
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If current, may we contact your employer?
Yes
No |
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2. Name and address of employer:
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From:
To:
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Immediate Supervisor:
Phone #:
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Position:
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Staring Salary:
Ending Salary:
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Please describe job duties:
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Reason for Separation/Desire to change:
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If current, may we contact your employer?
Yes
No |
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3. Name and address of employer:
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From:
To:
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Immediate Supervisor:
Phone #:
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Position:
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Starting Salary:
Ending Salary:
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Please describe job duties:
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Reason for Separation/Desire to change:
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If current, may we contact your employer?
Yes
No |
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PROFESSIONAL REFERENCES |
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1. Name:
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Profession/Affiliation:
Phone#/E-mail:
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2. Name:
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Profession/Affiliation:
Phone#/E-mail:
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3. Name:
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Profession/Affiliation:
Phone#/E-mail:
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Attach your resume: (You can also attach Degrees, Professional Certificates, License or Training Certificates)
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| The facts set forth in my application are true and complete. I understand that if employed, any false statement on this application may result in my dismissal. I further understand that this application is not a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one other than an officer of the Company has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in writing signed by an officer. |
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Name of Applicant:
Date:
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| “Under Maryland law an employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.” |
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Name of Applicant:
Date:
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AGREEMENT, AUTHORIZATION, AND CONSENT FOR RELEASE OF BACKGROUND INFORMATION |
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I, Last Name:
First Name:
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Middle Name:
Suffix: (If any)(Jr./Sr./I/II)
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understand that in conjunction with my application for employment, work to be performed under contract, promotion, reassignment, and/or retention, Vesta, Inc. will use the services of an outside agency to research and verify the information I have provided on my application for employment including my personal background, character, professional standing, work history and qualifications. This agency will provide a written report of its findings to Vesta, Inc.. Vesta, Inc. uses AbsoluteHire, a consumer-reporting agency, as an agent to perform its employment related background investigations.
AbsoluteHire will utilize various sources of information it deems appropriate including but not limited to: credit reporting agencies, workers compensation records including any and all injuries in compliance with the Federal ADA Act, department of motor vehicle records, criminal conviction records, current and former employers, military records, education records, professional and personal references. I agree, authorize and consent to the release and disclosure of any and all information including but not limited to the above to Vesta, Inc., and AbsoluteHire.
I agree, authorize and consent to the procurement of a Consumer Report and/or an Investigative Consumer Report and understand that it may contain information about my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This authorization in original or copy form shall be valid for my term of employment from the date indicated next to my signature. According to the Fair Credit Reporting Act, Vesta, Inc. will notify me if employment is denied because of information obtained from a Consumer Reporting Agency. Additionally, I understand that if requested within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all information provided to Vesta, Inc. I further understand that I may request a copy of the report, and that when doing so, proper identification will be required and I should direct my request to: AbsoluteHire, 3000 Lava Ridge Ct, Roseville, CA 95661. I understand that residents of all states will automatically receive a copy of the report if an adverse action is taken regarding the employment application, or upon request as outlined herein. |
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| LAW ENFORCEMENT AGENCIES AND OTHER ENTITIES FOR POSITIVE IDENTIFICATION PURPOSES REQUIRE THE FOLLOWING INFORMATION WHEN CHECKING PUBLIC RECORDS. IT IS CONFIDENTIAL AND WILL NOT BE USED FOR ANY OTHER PURPOSES. |
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Signed:
Today's Date:
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Printed Name:
Position Applied For:
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Social Security Number:
Date of Birth:
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Driver's License Number:
State:
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Other names you have used or are also known as:
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PLEASE PROVIDE ALL RESIDENTIAL ADDRESSES FOR THE PAST 7 YEARS
(Begin with your most recent or current address)
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1. Street and Apt.#:
City, State and Zip Code:
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From/To? (Mo./Yr.|Mo./Yr.)
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2. Street and Apt.#:
City, State and Zip Code:
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From/To? (Mo./Yr.|Mo./Yr.)
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3. Street and Apt.#:
City, State and Zip Code:
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From/To? (Mo./Yr.|Mo./Yr.)
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FOR MARYLAND HEALTHCARE FACILITIES ONLY
Places where you have been employed outside the state of Maryland for the past 7 years
(Required by the Maryland senate bill 312) |
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1. City and County:
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State:
Zip Code:
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2. City and County:
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State:
Zip Code:
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3. City and County:
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State:
Zip Code:
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FOR PROFESSIONAL LICENSES |
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Type of License:
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State:
License Number:
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Date Issued:
Expiration Date:
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Issuing Board:
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EDUCATIONAL CREDENTIAL VERIFICATION |
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School Name:
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School Address: (Steet, City, State and Zip Code)
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Years Attended: (From/To)
Major:
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Year Graduated:
Degree:
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Thank you for applying
at Vesta, Inc. |
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