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(785) 452-9580

436 S. Ohio St.
Salina, Kansas 67401

Careers At Independent Connection In Salina KS

Career Application

Apply Now

Independent Connection Inc. appreciates your interest in our organization, and we assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications and may assist us in possible future upgrading.

Career Application

Step 1 of 5 - Applicant Information

20%

Name:*
First Middle Last
Position Applying For:*
Phone:*
Email:*
Current Address:*
Street Address City State ZIP Code
Do you have a valid Drivers License?*
- Yes
- No
Drivers License Number:
Drivers License State:
Rate of Pay Expected:
Date Available:*
What type of work do you prefer?
- Full-time
- Part-time
Specify days and hours:
Are you known by another name?
- Yes
- No
If yes, by what name?
Have you ever been employed by Independent Connection Inc.?
- No
- Yes
If yes, when and what department?
List any relatives or friends currently employed by Independent Connection Inc.:
Are you a citizen of the United States or an alien authorized to work in the United States?*
- Yes
- No
Have you ever been convicted of a felony?*
- No
- Yes
If yes, please explain:
Are you 18 years of age or older?*
- Yes
- No

Education
Elementary:
Elementary School Name:
Elementary School Address:
Street Address Address Line 2 City State ZIP Code
Last Year Completed:
- 5
- 6
- 7
- 8
Did you graduate?
- Yes
- No
Course of Study:
List Diploma or Degree:
High School:
High School Name:
High School Address:
Street Address Address Line 2 City State ZIP Code
Last Year Completed:
- 1
- 2
- 3
- 4
Did you graduate?
- Yes
- No
Course of Study:
List Diploma or Degree:
College:
College Name:
College Address:
Street Address Address Line 2 City State ZIP Code
Last Year Completed:
- 1
- 2
- 3
- 4
Did you graduate?
- Yes
- No
Course of Study:
List Diploma or Degree:
Other (Specify):
School Name:
School Address:
Street Address Address Line 2 City State ZIP Code
Last Year Completed:
- 1
- 2
- 3
- 4
Did you graduate?
- Yes
- No
Course of Study:
List Diploma or Degree:
If you did not complete high school, do you have a high school equivalency diploma or certificate?
- No
- Yes
Date:
Other Special Training or Skills:

References

Give the names of three persons not related to you, whom you have known at least one year.

Reference #1:
Name:
Address:
Street Address Address Line 2 City State ZIP Code
Phone:
Years Acquainted:
Reference #2:
Name:
Address:
Street Address Address Line 2 City State ZIP Code
Phone:
Years Acquainted:
Reference #3:
Name:
Address:
Street Address Address Line 2 City State ZIP Code
Phone:
Years Acquainted:

Applicants Statement
I certify that the information contained in this application for employment is correct to the best of my knowledge and understand that falsification of this information is grounds for refusal to hire, or if hired, dismissal.

I authorize investigation of all statements contained herein. I also authorize the references above to give you all information concerning my previous employment and any pertinent information, personal or otherwise, they may have. Except as may be noted in regard to my current employer. I authorize other sources to provide you all information concerning my background. I release all parties from liability for any damage that may result from furnishing same to you.

In consideration for my being considered for employment by Independent Connection Inc., and in consideration for my employment, if hired, I agree to conform to the rules and regulations of Independent Connection Inc. I acknowledge that Independent Connection Inc.'s rules, regulations, benefits, and terms and conditions of employment may be changed, interpreted, withdrawn or added at any time, at Independent Connection Inc.'s sole option, without any prior notice to me. I acknowledge that any offer of employment may be withdrawn by Independent Connection Inc. at any time without prior notice to me. I acknowledge that if I am hired, my employment status with Independent Connection Inc. is that of an employee-at-will, and that my employment may be terminated at any time, with or without prior notice, by me or by Independent Connection Inc.

I understand that if I am hired no Independent Connection Inc. policy, rule, written or oral, changes my status as an employee-at-will. I understand that no representative of Independent Connection Inc. has the right or power to enter into an employment contract on behalf of Independent Connection Inc. with me or to make any agreement contrary to foregoing unless the contract is in writing and signed by the Director of Independent Connection Inc.
Please select the following:*
- I do not accept
- I accept the Independent Connection Inc. employment agreement.
Selecting accept & submitting this application for employment for Independent Connection Inc., you agree to the applicant statement.

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436 S. Ohio St.
• Salina, Kansas 67401

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