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The Leverage Team, LLC Job Application

Please complete the application on the following pages in its entirety. DO NOT LEAVE
ANYTHING BLANK. If a question does not apply to you or to the position for which you are
applying, please type “N/A” in the blank (N/A).

Please type your answers (do NOT handwrite). This form has been enabled so that you can
simply type the answers on your computer screen, using Microsoft Word. Note that the spaces
provided will expand to fit your answers, so do not worry about there not being enough space.

When you have finished completing your application, save it, print it, review it carefully, sign it,
and initial each page. You may then send it, ALONG WITH THE ADDITIONAL FORMS
REQUESTED ON THE “ADDITIONAL FORMS” PAGE, plus any tests (outlined on the
“Application Tests” page), by one of the following methods:

By fax to: David Oliver, 425-969-5836 (PREFERRED)


By email to: David Oliver at doliver72@usa.net
By mail to: David Oliver
470 Schooleys Mountain Rd
Hackettstown, NJ 07840
UNITED STATES

Please note that all positions begin on a PART-TIME, TRIAL basis. Unless otherwise indicated,
you are NOT applying for a full-time position, nor is continued employment guaranteed.

Applications will not be returned.

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Part 1: PERSONAL INFORMATION

Name:
(last) (first) (middle)
Address:
(street) (city) (state) (zip)
Email address:
Daytime phone: Evening phone: Fax:
Best time(s) to be reached by phone:
Disability: Click to select
Are you currently receiving Supplemental Security Income (SSI)? Yes No
Are you currently receiving Social Security Disability Income? Yes No
Do you receive any other supplemental income that limits how much money you can make each month?
Yes No
If “yes,” please specify your income limit: $
Do you have a Ticket to Work? Click to select

Part 2: POSITION INFORMATION

Position applying for (check all that apply)


Customer Service Representative
Writer
HR Administrator
Pay-Per-Click (PPC) Manager
Other (please indicate):
Desired hourly wage (in $/hour): $
Hours preferred per week:
Click to select
Briefly explain why you are interested in the position(s) for which you are applying:

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Part 3: EDUCATIONAL INFORMATION

HIGH SCHOOL
Name of school:
Location:
(city) (state) (zip)
Number of years completed: 1 2 3 4
Did you graduate? Yes No
If you did not graduate, did you obtain a GED? Yes No

COLLEGE/POST-SECONDARY EDUCATION (Please include any graduate work)


School #1
School:
Location:
(city) (state) (zip)
Degree earned? Yes No
If “no,” number of years completed:
Type of degree: BA BS AA Other (Please indicate):
Start date: End date:
Major(s):
Additional information:

School #2
School:
Location:
(city) (state) (zip)
Degree earned? Yes No
If “no,” number of years completed:
Type of degree: BA BS AA Other (Please indicate):
Start date: End date:
Major(s):
Additional information:

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Part 3: EDUCATIONAL INFORMATION (continued)

COLLEGE/POST-SECONDARY EDUCATION, continued (Please include any graduate work)


School #3
School:
Location: dss
(city) (state) (zip)
Degree earned? Yes No
If “no,” number of years completed:
Type of degree: BA BS AA Other (Please indicate):
Start date: End date:
Major(s):
Additional information:

School #4
School:
Location:
(city) (state) (zip)
Degree earned? Yes No
If “no,” number of years completed:
Type of degree: BA BS AA Other (Please indicate):
Start date: End date:
Major(s):
Additional information:

ADDITIONAL TRAINING
Describe any additional training you may have had that is relevant to the position(s) for which you are
applying:

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Part 4: COMPUTER & EQUIPMENT INVENTORY

Please mark “Yes” next to each item below that you own or have daily access to.
Please mark “No” next to each item that you do not own or do not have daily access to.
If needed, space has been provided after each item for comments/explanations.

COMPUTER & EQUIPMENT INVENTORY

Fax Yes No Comments?

Cell phone Yes No Comments?

Business phone Yes No Comments?

Home phone Yes No Comments?

Scanner Yes No Comments?

Laptop Yes No Comments?

Car Yes No Comments?

Large local library Yes No Comments?

Online library databases Yes No Comments?

MS Word Yes No Comments?

MS Excel Yes No Comments?

MS PowerPoint Yes No Comments?

MS Publisher Yes No Comments?

MS Access Yes No Comments?

Mozilla Firefox Yes No Comments?

Adobe Acrobat (Writer) Yes No Comments?

Other: Yes No Comments?

Other: Yes No Comments?

Other: Yes No Comments?

Please complete the questions below:


1. Typing WPM:
2. Kind of computer:
3. Computer age:
4. Computer Operating System (Windows 2000, Vista, etc.):
5. RAM (random access memory) on your computer:
6. Do you have a virus scanner? Yes No Name of virus software:
7. Free hard disk space: Used hard disk space:
8. Processing speed (GHz):
9. Do you have home Internet access? Yes No
10. What kind of Internet service do you have?
Click to select
If “other,” please specify:
11. Can you receive phone calls while you are online? Yes No Comment:
12. What telephone company handles your long distance phone calls?

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Part 5: SKILLS INVENTORY

Please complete the following skills inventory. For each skill, rank yourself from 1 to 10, with 1 meaning “no
knowledge or skill” and 10 meaning “extremely proficient.” Only check one box.

TASKS & SKILLS INVENTORY


No skill Moderate skill level Extremely proficient
Graphic design 1 2 3 4 5 6 7 8 9 10

Web design 1 2 3 4 5 6 7 8 9 10

Web programming 1 2 3 4 5 6 7 8 9 10

Internet marketing 1 2 3 4 5 6 7 8 9 10

Basic bookkeeping 1 2 3 4 5 6 7 8 9 10

Customer service 1 2 3 4 5 6 7 8 9 10

Typing 1 2 3 4 5 6 7 8 9 10

Transcription 1 2 3 4 5 6 7 8 9 10

Editing/Proofreading 1 2 3 4 5 6 7 8 9 10
Providing layout in Microsoft
1 2 3 4 5 6 7 8 9 10
Word
Writing 1 2 3 4 5 6 7 8 9 10

Creating press releases 1 2 3 4 5 6 7 8 9 10


Working with real estate MLS
1 2 3 4 5 6 7 8 9 10
systems
Practicing good organizational
1 2 3 4 5 6 7 8 9 10
capabilities
Teaching and coaching others
1 2 3 4 5 6 7 8 9 10
in computer skills
Creating PDFs 1 2 3 4 5 6 7 8 9 10
Exhibiting sound attention to
1 2 3 4 5 6 7 8 9 10
detail
Being tough on people when
1 2 3 4 5 6 7 8 9 10
needed to get things done
Following up with vendors 1 2 3 4 5 6 7 8 9 10

Making travel arrangements 1 2 3 4 5 6 7 8 9 10

Adhering to budgets 1 2 3 4 5 6 7 8 9 10

Doing tedious work 1 2 3 4 5 6 7 8 9 10


Speaking with people over the
1 2 3 4 5 6 7 8 9 10
phone
Conducting legal
1 2 3 4 5 6 7 8 9 10
research/writing
Completing human resource-
1 2 3 4 5 6 7 8 9 10
related tasks
Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

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Part 5: SKILLS INVENTORY (continued)

TASKS & SKILLS INVENTORY (continued)


No skill Moderate skill level Extremely proficient
Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Other: 1 2 3 4 5 6 7 8 9 10

Are you bilingual? Yes No


If yes, which language(s) do you speak?
Please feel free to provide any comments you may have with regards to your skill sets:

Part 6: MENTAL HEALTH KNOWLEDGE

Please indicate which of the mental health or addiction issues below you have firsthand experience with (either
yourself or someone you know). For “other,” please specify illness/disorder.

Mental Health Knowledge


No knowledge Moderate knowledge Extremely knowledgeable
Bipolar Disorder 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Depressive Disorders 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Schizophrenia 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Personality Disorders 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Addictions 1 2 3 4 5 6 7 8 9 10

Details/Comments:

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Part 6: MENTAL HEALTH KNOWLEDGE (continued)

Please indicate which of the mental health or addiction issues below you have firsthand experience with (either
yourself or someone you know). For “other,” please specify illness/disorder.

Mental Health Knowledge


No knowledge Moderate knowledge Extremely knowledgeable
Anxiety Disorders 1 2 3 4 5 6 7 8 9 10

Details/Comments:
Attention-Deficit/
1 2 3 4 5 6 7 8 9 10
Hyperactivity Disorder
Details/Comments:

Eating Disorders 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Phobias 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Self-Injury/Suicide 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Other: 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Other: 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Other: 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Other: 1 2 3 4 5 6 7 8 9 10

Details/Comments:

Part 7: EMPLOYMENT HISTORY

Are you currently employed? Yes No


If yes, may we contact your current employer? Yes No

Beginning with your most recent employer and working backward through the last 10 years, complete the following
section. If you worked for an employer more than once, fill out a separate entry for each season of employment.
Also include any time in the armed services and any part-time, volunteer, temporary, or seasonal
employment. If you need more space, please TYPE the information noted below for each additional employer on
a separate piece of paper, sign the paper, and submit along with your application.

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Part 7: EMPLOYMENT HISTORY (continued)

EMPLOYER #1 (most recent)


Name:
Location:
(city) (state) (zip)
Phone: Supervisor’s name:
Your position: Position description:
Dates of employment (month and year): to
(start) (finish)
Starting salary/hourly wage: $ Ending salary/hourly wage: $
Reason for leaving:

EMPLOYER #2
Name:
Location:
(city) (state) (zip)
Phone: Supervisor’s name:
Your position: Position description:
Dates of employment (month and year): to
(start) (finish)
Starting salary/hourly wage: $ Ending salary/hourly wage: $
Reason for leaving:

EMPLOYER #3
Name:
Location:
(city) (state) (zip)
Phone: Supervisor’s name:
Your position: Position description:
Dates of employment (month and year): to
(start) (finish)
Starting salary/hourly wage: $ Ending salary/hourly wage: $
Reason for leaving:

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Part 7: EMPLOYMENT HISTORY (continued)

EMPLOYER #4
Name:
Location:
(city) (state) (zip)
Phone: Supervisor’s name:
Your position: Position description:
Dates of employment (month and year): to
(start) (finish)
Starting salary/hourly wage: $ Ending salary/hourly wage: $
Reason for leaving:

EMPLOYER #5
Name:
Location:
(city) (state) (zip)
Phone: Supervisor’s name:
Your position: Position description:
Dates of employment (month and year): to
(start) (finish)
Starting salary/hourly wage: $ Ending salary/hourly wage: $
Reason for leaving:

EMPLOYER #6
Name:
Location:
(city) (state) (zip)
Phone: Supervisor’s name:
Your position: Position description:
Dates of employment (month and year): to
(start) (finish)
Starting salary/hourly wage: $ Ending salary/hourly wage: $
Reason for leaving:

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Part 8 VOLUNTEER WORK/ACTIVITES

In the space below, please provide details regarding any extracurricular and/or volunteer activities in which you
may currently be or recently have been involved:

In the space below, please provide details regarding any sports in which you may currently or previously have
been involved; include the duration of involvement in each sport:

Part 9 GENERAL QUESTIONS

Have you ever applied for a job with The Leverage Team before? Yes No
If yes, please note when:
If yes, and you applied under a different name, please note name you applied under:

Are you legally authorized to work in the United States? Yes No

Will you now or in the future require sponsorship for employment visa status (e.g. H-1B visa)?
Yes No

Within the last 5 years, have you been convicted of, pled guilty, or pled “no contest” to a crime (crime means
felonies and misdemeanors, including vehicular misdemeanors and felonies) or been released from
prison? (Applicants for employment in Hawaii should not answer this question at this time. Applicants in
California should not answer this question as it relates to marijuana-related convictions more than 2 years
old under California Health and Safety Code Sections 11357 (b) and (c), 11360 (c), 11364, 11365, or
11550, convictions that have been sealed, expunged, or legally eradicated, misdemeanor convictions for
which probation was completed and the case was judicially dismissed, or any information concerning a
referral to and participation in any pretrial or post-trial diversion program.)
Yes No

If yes, please briefly describe the nature of the crime(s), the date and place of conviction, and the legal disposition
of the case. The Leverage Team will not deny employment to any applicant solely because the person has
been convicted of a crime. Employer may, however, consider the nature, date, and circumstances of the
offense, as well as whether the offense is relevant to the duties of the position for which the applicant is
being considered.

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Part 10: REFERENCES

Please provide the names and contact information below for THREE (3) professional references. Do not list
personal references. Previous supervisors, job coaches, etc. are acceptable references. If you are a recent
graduate, academic references are acceptable.

PROFESSIONAL REFERENCE #1
Full Name: Title:
Organization: Phone:
Professional relationship: Years Associated:

PROFESSIONAL REFERENCE #2
Full Name: Title:
Organization: Phone:
Professional relationship: Years Associated:

PROFESSIONAL REFERENCE #3
Full Name: Title:
Organization: Phone:
Professional relationship: Years Associated:

Part 11: WHY YOU SHOULD BE HIRED (optional)

NOTE: This section is optional.


In the space provided below, please indicate why you are interested in this position and why you think you would
be good for the job. You may also use this space to provide additional information and/or clarification for any of the
questions in this application.

Part 12: HOW YOU HEARD ABOUT THIS JOB

Please indicate how you heard about this job opportunity (be specific). If Craigslist, please indicate region/city:

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Part 13: CERTIFICATON

Please carefully read the following information before signing this application.

I assert that the information and statements set forth in this application and all accompanying paperwork (Form
8850, Form 9160, Form I-9, Form W-2, and any applicable job-specific tests) are accurate, complete, and
true.
I authorize The Leverage Team, LLC to obtain information from previous employers about me, including relevant
facts and opinions about my work and work habits, and I release from liability or responsibility all persons
or entities requesting or supplying such information. I release The Leverage Team, LLC from liability for
considering, relying on, or taking into account information it receives from such persons or entities.
I expressly authorize any educational institutions that I have attended to provide transcripts and degree status. I
release from liability or responsibility all persons or entities requesting or supplying such information. I
release The Leverage Team, LLC from considering, relying on, or taking into account information it
receives from such persons or entities.
I understand that any false information or significant omissions on this application may disqualify me from further
consideration for employment, and that, if employed, false information or significant omissions on this
application shall be grounds for immediate termination of employment.
If employed by The Leverage Team, LLC, I agree to adhere to company policies and procedures, although I
understand that my agreement to do so does not create a contract of employment between myself and
Employer. I further understand that, if hired by The Leverage Team, LLC, employment is not for a specific
duration and may be terminated by me or Employer at any time, for any reason or for no reason
whatsoever, with or without notice and with or without cause to the fullest extent allowed by law.
All employees with The Leverage Team, LLC are “at will” employees to the fullest extent allowed by law. No
statements made in The Leverage Team, LLC’s handbook or in any other policy or guideline documents
creates a contractual promise from The Leverage Team, LLC to its employees.
I further understand that The Leverage Team may change any terms of my employment, including but not limited
to work assignments, job duties, work schedules, pay levels, commissions earnings and eligibility, bonus
amounts and eligibility, and/or locations.
If employed by The Leverage Team, LLC, I agree to sign and abide by the Company’s Non-Disclosure and Non-
Compete Agreements and the Invoicing Rules and Regulations.
I understand that any offer of employment is contingent upon a satisfactory background check. If hired, I
understand that the authorization I will provide to The Leverage Team for an initial background
investigation to be conducted will remain in effect and will serve as an ongoing authorization for The
Leverage Team, LLC to procure a background report at any time before or during my employment with
The Leverage Team, LLC.
I understand that if I am offered employment by The Leverage Team, LLC, it is contingent on my ability to furnish
proof of my identity and U.S. citizenship, or to furnish legal authorization for me to work in the U.S., as
required by federal law. Failure to do so and/or lack of proper documentation (within 3 days of hire) will
result in termination of employment pursuant to the Immigration Reform and Control Act of 1986.
I understand that nothing contained in this employment application or in the granting of an interview is intended to
create an employment offer or contract between The Leverage Team, LLC and me.
I understand that no supervisor, manager, or executive of The Leverage Team, LLC, other than the CEO, has the
authority to alter the foregoing, and only a written contract signed by the CEO may modify The Leverage
Team, LLC’s at-will employment policy.
By signing this application, I indicate my understanding of all the above factors.

Applicant Signature:
Applicant Printed Name:
Date:

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FOR COMPANY USE ONLY

Prescreen:

Interview #1:

Interview #2:

Interview #3:

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