HIRE FORM

This form is to be completed by the Candidate and submitted to the

Human Resources Office for approval before an employee can be hired.

GENERAL INFORMATION

FIRST NAME: LAST NAME: MIDDLE INITIAL:

EMAIL
LAST 5 SSN # DOB:
ADDRESS:
HOME CELL
SKYPE ID# ( ) - ( ) -
PHONE: PHONE:

ADDRESS: CITY: STATE: ZIP:

MARTIAL STATUS: SINGLE MARRIED

GC EAD GREEN CARD CITIZEN REFUGEE OTHERS :LIST OTHERS:

VISA STATUS:
OPT START DATE: EXPIRATION DATE: H1-B EXPIRATION DATE:
REQUIRE VISA SPONSERSHIP Yes No ___________
(H1/GREENCARD) (EXPECTED DATE OF SPONSERHIP)

EMPLOYEMENT INFORMATION

HAVE MANY YEARS HAVE YOU LIVED IN UNITED STATES?

ARE YOU CURRENTLY EMPLOYEED? START DATE END DATE

Yes NO (IF KNOWN)

POSITION OR TYPE OF EMPLOYEMENT DESIRED

NOTICE PERIOD
AVAILABLE DATE TO START WORKING YES NO
REQUIRED
LOCATION PREFERENCES
ARE YOU WILLING TO RELOCATE Yes NO (EVERYWHERE, ENTIRE EAST
COAST, CENTRAL, PACIFIC)

AVAILABILITY FOR SKYPE (DAY/WEEK) TIME?

ARE YOU TRAVELING OUTSIDE OF THE COUNTRY IN THE NEXT Yes No

3 MONTHS? (IF YES, EXPECTED DATE OF LEAVING)

EDUCATION AND TRAINING INFORMATION

HIGH SCHOOL GRADUATE OR GENERAL EDUCATION (GED) TEST PASSED? Yes No

IF NO, LIST THE HIGHEST GRADE COMPLETED

Revised 06.2011
MOST RECENT COLLEGE
DATES ATTENDED OTHERS GRADU DEGREE & YEAR MAJOR OR SUBJECT
NAME AND LOCATION MONTH/YEAR (SPECIFY) ATED

FROM TO Yes DEGREE

YEAR
No

FROM TO Yes DEGREE

YEAR
No

FROM TO Yes DEGREE

YEAR
No

FROM TO Yes DEGREE

YEAR
No

OCCUPATIONAL LICENCE, CERTIFICATE NUMBER WHERE EXPIRATI

ISSUED ON DATE

OCCUPATIONAL LICENCE, CERTIFICATE NUMBER WHERE EXPIRATI

ISSUED ON DATE

EMERGENCY CONTACT

EMERGENCY CONTACT 1

FIRST NAME: LAST NAME: RELATIONSHIP:

PRIMARY PHONE NUMBER ALTERNATIVE PHONE NUMBER

ADDRESS: CITY: STATE: ZIP:

EMERGENCY CONTACT 2

FIRST NAME: LAST NAME: RELATIONSHIP:

PRIMARY PHONE NUMBER ALTERNATIVE PHONE NUMBER

ADDRESS: CITY: STATE: ZIP:

Digiinfotek does not discriminate on the basis of race, age, creed, color, religion, national origin or ancestry, sex, gender, disability, veteran
status, genetic information, sexual orientation, gender identity or expression, or pregnancy. Digiinfotek is an equal opportunity/equal
access/affirmative action employer fully committed to achieving a diverse workforce and complies with all Federal and State laws, regulations,
and executive orders regarding non-discrimination and affirmative action.

Revised 06.2011