Application for Employment
Merit Corporation
1640 Franklin Place
Washington, DC 20041
Phone (730)-929-6213
Merit Corporation is an equal opportunity/affirmative action employer.
Hiring Guidelines for Merit Corporation
 Applications will not be accepted via fax or email.
 An application must be complete and signed before an individual is
considered an applicant. Resumes and cover letters are not accepted
in lieu of a completed application but are required as part of the
application process.
 Applicants, including temporary employees are required to submit a
complete application packet to be considered for a vacancy.
 You will be notified if an interview is to be scheduled
 Applicants must submit an application packet for each position they
want to be considered as a candidate.
 Once a position has been filled, applicants will be notified.
All positions require the following information to be considered for the
position
 Application with original signature
 Letter of interest
 Resume
Applicant Information
Date of application
Name:
Address:
Day time phone:
Merit Corporation Application for Employment
Social Security Number:
555-55-5555
Are you younger than 18 years of age
Yes
No
Are you a US Citizen or an alien authorized to work in the U.S.?
Yes
No
(Proof of U.S. Citizenship or Immigration Status will be required upon employment)
Desired Employment
Position Applying for:
Date available:
Are you currently employed?
Yes
No
If so, may we inquire of your present employer?
Yes
No
Have you ever applied for a position at Merit Corporation? Yes
Have you ever worked for Merit Corporation? Yes
No
No
If yes, Please state the reason for leaving.
Who was your Supervisor?
Who referred you to Merit Corporation?
Employment Agency
Newspaper Ad
College Placement service
Walk in Other:
Friend
State Employment Office
Education Skills
High School
Graduate/GED Yes No
Year graduated
Trade/ Business School
Certified?
Yes
No
Field of Study:
College
College Graduate?
Some College
Yes
Hrs:
Degree:
School Name:
School Name:
Institution Name:
Special Training :
Special Skills:
Languages you can speak, read and /or write:
Employment History
Name of Present or Last Employer
Address
City
State
Starting Date
Termination Date
Job Title
Starting Salary
Ending Salary
May we contact your supervisor?
Zip
No
Merit Corporation Application for Employment
Yes
Title
Supervisor Name
No
Phone
Duties of your position
Reason for leaving position
Name of Previous Employer
Address
City
State
Starting Date
Termination Date
Job Title
Starting Salary
Ending Salary
May we contact your supervisor?
Yes
No
Title
Supervisor Name
Zip
Phone
Duties of your position
Reason for leaving position
Name of Present or Last Employer:
Address
City
State
Starting Date
Termination Date
Job Title
Starting Salary
Ending Salary
May we contact your supervisor?
Yes
No
Title
Supervisor Name
Duties of your position
Reason for leaving position
References
Zip
Phone
Merit Corporation Application for Employment
Only include individuals familiar with your work ability. Do not include relatives
Name
Phone
Years Known
Name
Phone
Years Known
Name
Phone
Years Known
Certification and Acknowledgement
I certify that all information submitted in this application form, or in any resume, interview, or any other information
is true and complete and that I have not knowingly withheld, nor will I withhold, any information that would affect my
application for employment. I understand that the employer is under no obligation to consider or reconsider this
application at any time, and that acceptance of my application does not constitute an offer of employment. I also
understand and agree that :
1. Inquires may be made with my previous employers or others who may have knowledge of me, or with
consumer credit, investigative or other private governmental agencies. I authorize any such person or agency to give
you any and all information concerning my previous employment, including but not limited to as assessment to my job
performance, ability and fitness, and/or any other information they may have, personal or otherwise, along with
reasons for termination of past employment from previous employers, and release all parties from any and all ability,
claims or damages that may directly or indirectly result from furnishing same. Further, I understand that you will be
requesting information concerning my workers’ compensation claims; motor vehicles information will only be
requested in compliance with the ADA. Upon my reasonable and timely request, a description of the general scope
and nature of any such inquiry will be provided to me.
2. Prior to my beginning work, or during my employment, The employer reserves the right to require any
lawful form of medical, drug, alcohol, psychological, character, honesty, integrity, aptitude skill or other test or
examinations.
Signature:
Date
Optional Affirmative Action Information
The purpose of this section is to assist in mounting Affirmative Action Programs and to aid in complying with any required
Governmental records keeping or periodic reporting. This information is not part of your employment application, and will not be
considered in the employment/selection process. If you choose to provide the information please complete the following:
Title of Job Applied for:
Birth Date
Race
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American Indian –origins in North America, to include Alaska
African American –origins in Africa
Asian American – Origins in Far East, SE Asia, India or Pacific Islands
Merit Corporation Application for Employment
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Hispanic –Mexican, Puerto Rican, Cuban, Central or South American
White –origins in Europe, North Africa, or Middle East
Sex
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Male
Female
Physical Condition
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No Disability
Physically Disabled (No facility modifications needed)
Physically Disabled (Facility modification needed)
Mentally Disabled
Developmentally Disabled
Veteran/ US Military Status
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Non-Veteran
Pre-Vietnam Veteran
Pre-Vietnam Veteran with service incurred disability
Vietnam Era Veteran (8/64-5/75)
Vietnam Era Veteran with service incurred disability
Post Vietnam Veteran
Post Vietnam Veteran with service incurred disability
Active National Guard or Reservist
□
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Yes
□
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Yes
No
Special examination procedures for people with disabilities may be arranged upon request. Do
you require special testing procedures?
No