Employment Application SSFM International, Inc. is an Equal Opportunity Employer – Minority/Female/Disability/Veteran/Current Unemployment Status. Voluntary InformationThe information requested is needed for legally permissible reasons, including, without limitation, national security considerations, a legitimate occupational qualification or business necessity. Please check the appropriate boxes that apply to you. I choose not to disclose Ethnic BackgroundAfrican AmericanAsianHispanicNative AmericanPacific IslanderCaucasianTwo or More RacesGenderMaleFemaleVeteran StatusI identify as one or more of the classifications of protected veteran listed below.I am not a protected veteran.I choose not to disclose.Veteran ClassificationThe veteran classifications are defined as follows: A “disabled veteran” is one of the following: (a) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or (b) a person who was discharged or released from active duty because of a service-connected disability. A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service. An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An “Armed Forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.Voluntary Self-Identification of DisabilityForm CC-305 OMBOMB Control Number 1250-0005 Expires 1/31/2017 Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing,we are askingyou to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and willnot be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. A “disabled veteran” is one of the following: (a) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or (b) a person who was discharged or released from active duty because of a service-connected disability. A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service. An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An “Armed Forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness Autism Bipolar disorder Post-traumatic stress disorder (PTSD) Deafness Cerebral palsy Major depression Obsessive compulsive disorder Cancer HIV/AIDS Multiple sclerosis (MS) Impairments requiring the use of a wheelchair Diabetes Epilepsy Schizophrenia Muscular dystrophy Missing limbs or partially missing limbs Intellectual disability (previously called mental retardation) Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.Please tell us ifyou require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the applicationprocess or work procedures, providing documents in an alternate format,using a sign language interpreter, or using specialized equipment. Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.Disability Disclosure*YES, I HAVE A DISABILITY (or previously had a disability)NO, I DON’T HAVE A DISABILITYI DO NOT WISH TO ANSWERName*Today's Date* Contact InformationFirst Name*Middle NameLast Name*Street Address*City*Postal Code*Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweEmail* Phone Number*Best Contact MethodPhoneEmailBest Time to Call : HH MM AM PM Job InformationPosition Desired*Salary Desired*Position Location*HonoluluKaua'iMauiHiloGuamOkinawaManilaShanghaiKapoleiEducation (300 words maximum)* Employment History1. Employera. Addressb. Phone Numberc. Name & Title of Supervisord. Your position and dutiesNote: “see resume” is okaye. Start Date (mm/yyyy)f. End Date (mm/yyyy)g. Starting Base Payh. Ending Base Payi. Reason for Leavingj. May we contact your employer for a reference? Yes No Professional License/Certificationsa. License/Certification Typeb. Numberc. Stated. Year Obtainede. Current? Yes No References1st Reference Name*Relationship to Applicant*Contact Number*Email* 2nd Reference NameRelationship to ApplicantContact NumberEmail 3rd Reference NameRelationship to ApplicantContact NumberEmail Upload or Paste Resume/CV*Upload a ResumePaste a ResumeSelect a method for adding your resume.Resume/CVAccepted file types: pdf, doc, docx.If you have a CV or resume, please upload it here. (PDF or Word documents only. File size cannot exceed 5MB.)Paste a Resume Upload or Paste Cover letterUpload a Cover letterPaste a Cover letterSelect a method for adding your Cover letter.Cover letterAccepted file types: pdf, doc, docx.If you have a Cover letter, please upload it here. (PDF or Word documents only. File size cannot exceed 5MB.)Paste a Cover letter Please Read Carefully Before SubmittingA. I certify that the information contained in this application is true and correct. I understand that any false or misleading statements or omissions regarding this application, whenever discovered, are grounds for disqualification from further consideration or for dismissal from employment. B. If employed, I agree to conform to the guidelines and policies of SSFM International, Inc., otherwise known as SSFM. I understand that MY EMPLOYMENT IS AT-WILL AND CAN BE TERMINATED AT ANY TIME AND FOR ANY REASON WITH OR WITHOUT ADVANCE NOTICE. C. I understand and agree that only the President of SSFM has the authority to enter into agreement to employ me for any specified period of time or to modify terms and conditions of my employment. I agree that such an agreement must be in writing and signed by the President, and I will not rely upon anything else. D. I understand and agree that SSFM may make full and complete investigation of my personal or employment history, and authorize any former employer, person, firm, corporation, school, government agency, or other entity to provide SSFM with any information (including fact or opinion) they may have regarding me. In consideration of SSFM's review of this application, I release the company and all providers of any information from any liability which may arise as a result of furnishing and receiving this information, with the exception of any liability arising from a violation of the Fair Credit Reporting Act (FCRA). I understand and agree that if offered employment by SSFM, any such employment offer shall be dependent upon the receipt of satisfactory references as determined by the Company. E. I understand and agree that I may be required to submit to drug testing and a complete post offer medical examination as part of my application for employment. I also understand and agree that I may be required to submit to a complete medical examination during my employment with the Company, provided that such examination is job related and consistent with business necessity. The cost of such examination will be paid by the Company. I authorize the physician conducting the examination and any laboratory testing any specimen obtained by the physician or collection site to disclose the results of the examination to SSFM in accordance with state and/or federal laws. SSFM shall keep such results confidential and disclose the results only to persons who need to know or are required by law to know. Also, I agree to fully cooperate and provide SSFM with any additional consent(s) and/or release(s) as required by the Company to investigate my employment application. F. SSFM may inquire into and consider any criminal conviction record that you may have after it makes a conditional offer of employment to you. SSFM may withdraw a conditional employment offer if you have a criminal conviction record which bears a rational relationship to the duties and responsibilities of the position for which you are applying. Any criminal conviction record that is more than 10 years old or that involves certain Family Court matters will not be considered. G. I understand and agree that if offered employment by SSFM, I may be required to disclose military service information in accordance with law, and that such employment offer shall depend upon the receipt of a satisfactory military record as determined by SSFM. H. I understand that all of the foregoing terms and conditions will become part of my employment relationship with SSFM if the Company employs me. Acknowledgement*I acceptI don't acceptHow did you learn about the position you are applying for?Job FairSSFM WebsiteLinkedinHirenetFriendOtherPlease State SSFM International, Inc. does not discriminate in employment on the basis of race, color, religion, sex (including gender identity or expression), national origin, sexual orientation, marital status, disability, age, religion, ancestry, arrest and court record, citizenship, credit history, veteran/military status, status as a victim of domestic or sexual violence, or genetic information.NameThis field is for validation purposes and should be left unchanged.