Desert Management Associates of Arizona, Inc. dba InvisionHR
Independent Contractor Application Form
* = Required Field
Personal Information
How did you find out about the job position?*
Have you ever applied or worked
for this company before?		 No    Yes
Last Name: *
First Name: *
Middle Name:
Current Address:
City:
State / Zip Code:   
How long at this address?
Home Phone (Include Area Code): *     - 
Cell Phone (Include Area Code):     - 
E-Mail Address:
If under 18, please list age:
Have You Ever Been Convicted of a Felony? No    Yes
Availability
Are you currently under contract with another staffing firm? Yes    No
Do you currently have a non-compete agreement? Yes    No
Days Available? M   T   W   Th   F   Sa   Su
Education
Type of School:
Name of School:
School Location:
# of Years Completed:
Major & Degree:
Degree:
High School:
College:
REFERENCES
Please list two references other than relatives or previous employers.
REFERENCE 1:
Name:
Address:
City:    
Phone:
REFERENCE 2:
Name:
Address:
City:    
Phone:
Employment History
Work Experience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
Employer # 1
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Start Date (Month / Year):
End Date (Month / Year):
Reason For Leaving:
Employer # 2
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Start Date (Month / Year):
End Date (Month / Year):
Reason For Leaving:
Employer # 3
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Start Date (Month / Year):
End Date (Month / Year):
Reason For Leaving:
Employer # 4
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Start Date (Month / Year):
End Date (Month / Year):
Reason For Leaving:
Employer # 5
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Start Date (Month / Year):
End Date (Month / Year):
Reason For Leaving:
REFERRAL
Who (if anyone) referred you?
TERMS AND CONDITIONS
In exchange for the consideration of my application to InvisionHR (hereinafter called "the Company"), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of contractual relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain a contractor or become an employee of InvisionHR, or otherwise to in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and the Company may end the contractual relationship at any time, without specified notice or reason.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.

I understand that, in connection with the routine processing of your application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

Initials:


This Company is an equal employment opportunity employer. We adhere to a policy of making contract decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in InvisionHR.