New Employee Information – Southam and Associates

Date / Time

Date

Time

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Who referred you to our company?

Date you are available to begin work: *

Desired hourly wage: *

Have you been convicted of a felony in the past five years? *

Yes
No

Have you previously worked at Southam and Associates? *

Yes
No

Are you legally eligible to work in the US? *

Yes
No

Are you able to meet the attendance requirements of this job? See Attendance & Punctuality Policy *

Yes
No

If the position requires it, are you willing to work out of town for extended periods of time? *

Yes
No

Are you able to meet the attendance requirements of this job? See Attendance & Punctuality Policy in the Employee Handbook for details: *

Yes
No

Have you entered into an agreement with a former employer or any other party (union or noncompete that might in any way restrict your ability to work for our company? *

Yes
No

Please list your emergency contact name and cell phone number: *

By typing your name below, you confirm that this application was completed by you and all entries and information on it are true and complete to the best of your knowledge. If hired, you understand that your employment will be at-will, meaning you can quit or be fired for any reason or no reason with or without any notice or formality. Signed: *