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On-line Application for Employment

In connection with my application for employment with you, I understand that SuperPeople Inc. will make inquiries into my background. These will include records of criminal convictions, motor vehicle records and other reports. These reports will include information about my character, work habits, performance and experience, as well as reasons for termination by previous employers. Furthermore, I understand that SuperPeople Inc. will be requesting information from various Federal, State and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences.

 
Full Name         Today's date  
Soc. Sec.    - -     Date of birth      Sex   (M / F)
Drivers License #      EXP Date   mm/dd/yy
Address    
City                State   Zip
Home phone     Cell/Pager   
E-mail:  
In the case of an emergency please contact:  
Relationship:   Number:  
Other counties/cities/states In which I have resided or worked within the past 7 years.
Have you ever been convicted of a crime? (Misdemeanor, felonies, etc.)
Y   N    If yes, explain
Position you are applying for:
In what area do you prefer to work?
Are you willing to travel?
Special skills, licenses or training related to your ability to perform the functions
of the position you are applying for
*** Pay rate you are requesting per hour  
SuperPeople, Inc., does not discriminate or consider as conditions for employment, race, color,
religion, national origin, sex, marital status, disability, age or veteran status. Receipt of this
application does not imply or guarantee employment.
Full Name:  
How did you hear about SuperPeople Inc:
Should you have a current resume please skip this section
PREVIOUS EMPLOYMENT HISTORY
1. Company Name Supervisor
Address Dates:  From  To
Phone# Salary
Reason for leaving
Position & Duties  
2. Company Name Supervisor
Address Dates:  From  To
Phone# Salary
Reason for leaving
Position & Duties  
3. Company Name Supervisor
Address Dates:  From  To
Phone# Salary
Reason for leaving
Position & Duties  
Please check the items that pertain to you:
AMSI
Uses public transportation
Rent Roll
Yardi
Bilingual
Blue Moon 		Property Manager
Property Supervisor
Assistant Manager
Leasing Agent: Experience
Leasing Agent: No Experience
Receptionist 		EPA Lead Maintenance
EPA Maint. Supervisor
Lead Maint. No EPA
Assistant Maint.
Makeready
Porter W/ Pools
Porter W/O Pools
Housekeeper
This section to be completed at Super People office.

First Health/ AIGCS Health Care Network Plan : Acknowledgement Form
AIG Claim Services
If I am hurt on the job and live in the service area described in this information, I
understand that:
    1) I must choose a treating doctor from the list of doctors in the network. Or, I
    may ask my HMO primary care physician to agree to serve as my treating doctor.
    2) I must go to my treating doctor for all health care for my injury. If I need a
    specialist, my treating doctor will refer me to one. If I need emergency care, I
    may go anywhere. 3) The insurance carrier will pay the treating doctor and other
    network providers. 4) I might have to pay the bill if I get health care from someone
    other than a network doctor without network approval.


APPLICANT SIGNATURE   DATE
   
PRINTED NAME    



I LIVE AT: STREET ADDRESS
   
  CITY            STATE ZIP                    CODE



NAME OF EMPLOYER: Super People, Inc.
3730 Kirby Dr. #1200
Houston, Texas 77098
866.533.0301 Phone
866-533-0308 Fax

NAME OF NETWORK:
First Health



Please indicate whether this is the:

_________ Initial Employee Notificaiton

_________ Injury Notification (Date of Injury) ____/____/____
  Safety Guidelines
  Initial Yes, I have read, understand and agree to the statement.
  Applicant Authorization/Employee Terms
  Initial Yes, I have read, understand and agree to the statement.