AYRES ASSOCIATES

Please fill out the form below completely to apply for a position with Ayres Associates.

* Position Number:

Date:

Upload Resume:

* First Name:

* Last Name:

MI:

* Present Street Address:

* City:

* State:

* Zip:

* Email Address:

Home Telephone:

YES	NO
		* Are you currently authorized to work in the United States on a full-time basis for any employer?

		* Will you now or in the future require sponsorship for employment-based immigration status (for example H-1B status)?

		* Do you have an employment agreement or contract with your current employer?

		* Have you had an employment agreement or contract with a previous employer?

		* Are you 18 or older?

School Type:	School Name:	School Location:	No. of Years Attended:	Did you graduate?	Degree / Major:

High School:

Post High School:

Present or Last Employer

Name of Employer:

Nature of Business:

Telephone Number:

Address:

City:

State:

Zip:

Dates
Employed:

From:

To:

Position:

  Starting
  Base Salary:

  Ending
  Base Salary:

Reason for Leaving:

May we contact?

Job Description:

Next Previous Employer

Name of Employer:

Nature of Business:

Telephone Number:

Address:

City:

State:

Zip:

Dates
Employed:

From:

To:

Position:

  Starting
  Base Salary:

  Ending
  Base Salary:

Reason for Leaving:

May we contact?

Job Description:

Next Previous Employer

Name of Employer:

Nature of Business:

Telephone Number:

Address:

City:

State:

Zip:

Dates
Employed:

From:

To:

Position:

  Starting
  Base Salary:

  Ending
  Base Salary:

Reason for Leaving:

May we contact?

Job Description:

Please list any additional employment not shown or any information you believe would be helpful to us. If you have additional employment history relevant to this position, please e-mail a resume to Jamie Meyer or fax to 1.800.338.7306.

Additional Information:

Please list any job-related certifications or registrations you currently have:

Give the names of three people that we may contact who are not related to you and you have known professionally for at least one year:

Name of Reference:	Phone Number:	Reference's Position or Relationship to You:

We assure you that your opportunity for employment with this company will be based solely on your merit and on no other consideration.

Are you able to perform the tasks of the job for which you are being considered, with or without a reasonable accommodation?

		Yes, no accommodation needed.

		Yes, with the following accommodation:


		No

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I affirm that I have a genuine intent and no other purposes in applying for a job with Ayres Associates.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liablity for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice."

* Electronically Signed By:

Date:

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.

Completion of Information Below is Voluntary

Ayres Associates Web Site	Other Web Site	School

Newspaper Ad	Employee	Relative

Government Employment Agency	Private Employment Agency	Walk-in

Other Source (name if applicable):

As required, we comply with government regulations including Affirmative Action obligations where they apply. In an effort to comply with requirements regarding government recordkeeping, reporting and other legal obligations, we ask that you complete the applicant data survey below. Your cooperation is appreciated.

We consider applicants for all open positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status. Completion of this form is voluntary and in no way affects the decision regarding your employment opportunity. The information provided below will be held in the strictest confidence and will be maintained in a separate file. This survey is not a part of your official application for employment.

Male

Female

	Hispanic or Latino

	White (not Hispanic or Latino)			Black or African American (not Hispanic or Latino)
	Asian (not Hispanic or Latino)			Native Hawaiian or other Pacific Islander (not Hispanic or Latino)
	American Indian or Alaska Native (not Hispanic or Latino)
	Two or More Races (not Hispanic or Latino)
	If you selected "Two or More Races" which race do you primarily identify with?

Please submit your application or you may clear the form.

APPLICANT POLICY

1\|	Applications are accepted only for posted positions. Unsolicited resumes/applications will not be retained. A list of our positions is available in the Career Opportunities section.
2\|	Applications of candidates without authorization to work in the U.S. will not be considered or retained.
3\|	Applications will be accepted via this online application form or at our corporate headquarters via mail at 3433 Oakwood Hills Parkway, Eau Claire, WI 54701, e-mail, or fax (1.800.338.7306).
4\|	All applicants who submit a resume must fill out an application form for further consideration. An application form may be requested from our corporate headquarters or submitted using this online form.
5\|	Applications will be retained for future openings for 60 days.