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EMPLOYMENT APPLICATION

* GROUPGLOBAL.NET is an Equal Opportunity Employer

* Should you have any questions, please call 1-800-815-3205

1. Select the job you are applying for

2. Application Date

3. Personal Information

First Name
Middle Name
Last Name

4. Address

Street
City
State
Zip

5. Contact Information

Home Phone
Work Phone
Email

6. Social Security Number

7. Driver License

Do You Have a Valid Driver's License?	Yes No
Do You Have a Valid Commercial License?	Yes No

8. Have you Ever worked for GROUPGLOBAL.NET ?

Yes No

9. Are you eligible for lawful employment in the United States?

If yes, check this box
If hired by GROUPGLOBAL.NET , you will be required to provide proof of identity, and U.S. citizenship of your legal right to work in the United States.

10. Have you served in the armed forces?

Yes No

11. Have you ever resigned from or otherwise left any employment while allegations of misconduct or harassment on your part were pending or under investigation?

Yes No

12. Are you aware of any current investigation that may possibly result in criminal charges against you?

Yes No

13. Have you ever been discharged or forced to resign from any position?

Yes No

14. Have you used illegal drugs in the last 5 years?

Yes No

15. Have you ever been convicted of any violation of the law, other than minor traffic violations? (e.g. speeding is a minor violation, DUI and reckless driving are not )

Yes No

16. Are you related to any person employed by GROUPGLOBAL.NET ?

Yes No

17. Professional License or Certificate, if required

License Title	Serial No.	Date Issued	Expiration Date

18. Education

High School Graduate	If yes, check this box

College or University
Major Subjects
Date Attended	( e.g. 1/1/2003 )
Check if Graduated
Type of Degree

Graduate School
Major Subjects
Date Attended
Check if Graduated
Type of Degree

Vocational or Special Training
Major Subjects
Date Attended
Check if Graduated
Type of Degree

19. Work Experience

Begin with your present or last position including Orem GROUPGLOBAL.NET and Military employment and work back. Be specific. If more than one position was held under the same employer, describe each position separately. Describe your duties in concise detail. Indicate responsibility, supervision, if any, reason for leaving, etc. ( You might attach a resume or other relevant documents to further describe your qualifications.)

Dates of Employment	From To (e.g. 1/23/2000)
Title of Position
Ending Monthly Salary	[Numbers Only-No Commas, No Periods]
Name of Employer
Address
Phone
Supervisor
Reason for Leaving
Describe Your Duties

Dates of Employment	From To
Title of Position
Ending Monthly Salary	[Numbers Only-No Commas, No Periods]
Name of Employer
Address
Phone
Supervisor
Reason for Leaving
Describe Your Duties

Dates of Employment	From To
Title of Position
Ending Monthly Salary	[Numbers Only-No Commas, No Periods]
Name of Employer
Address
Phone
Supervisor
Reason for Leaving
Describe Your Duties

Dates of Employment	From To
Title of Position
Ending Monthly Salary	[Numbers Only-No Commas, No Periods]
Name of Employer
Address
Phone
Supervisor
Reason for Leaving
Describe Your Duties

20. May we contact your present employer?

Yes No
Inquiry may be made of your former employers or the last school you attended regarding your performance record.

21. Comments

22. Resume (Upload)
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QUESTIONNAIRE

The GROUPGLOBAL.NET CORP is asking all applicants for employment to complete this form in order to comply with United States Government Equal Employment Opportunity requirements. Data collected will be used for statistical purposes and to measure effectiveness of recruitment efforts. This information which you provide voluntarily will be detached from your application and will be kept separate and confidential. GROUPGLOBAL.NET CORP is an equal opportunity employer. If you feel you have been treated unfairly or discriminated against because of race, color, national origin, sex, age or disability, please contact the GROUPGLOBAL.NET 's Human Resources Office at 229-7186.

1. Your Birthday

2. Ethnic Origin

White:	All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Black:	All persons having origins in any of the Black racial groups of Africa.

Hispanic:	All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.

Asian or Pacific Islander:	All persons having origins in any of the original peoples of Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, Samoa, and the Philippine Islands.

American Indian or Alaskan Native:	All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

Other:	Other persons other than the above.

Disabled Applications: The Human Resources Office will make reasonable efforts in the examination process to accommodate disabled applicants. If you have special needs, please call: 1-800-815-3205.

By clicking the 'Submit' button, I authorize the GROUPGLOBAL.NET CORP to conduct a background investigation and authorize the release of information in connection with my application for employment. If required for the position, the background investigation may include information released to criminal or civil convictions and motor vehicle reports (driving records) obtained from appropriate sources, including previous employers. I understand that the information will be considered with my qualifications for employment with the GROUPGLOBAL.NET .

The GROUPGLOBAL.NET obtains Motor Vehicle Reports on employees whose job duties require operation of GROUPGLOBAL.NET owned motorized vehicles or equipment. If employed by GROUPGLOBAL.NET , I authorize the GROUPGLOBAL.NET of periodically obtain a Motor Vehicle Report. I understand that frequent or repeated traffic violations may affect my employment eligibility with the GROUPGLOBAL.NET .

I waive my right of access to such information and hereby release the GROUPGLOBAL.NET and the reference source from any liability in connection with the release or use of the information.

I understand that this employment application and any other GROUPGLOBAL.NET documents are not contracts of employment and that any oral or written statements to the contrary are hereby disavowed by the city.

The information I have given on this application for employment is true and complete and is subject to verification by the GROUPGLOBAL.NET . I also understand that any misrepresentation or falsification, regardless of when discovered, may subject me to disqualification or dismissal from employment with the GROUPGLOBAL.NET .

Massachusetts License # MC0124