EMPLOYMENT APPLICATION

PERSONAL INFORMATION If employed, this will become part of your permanent record with Clarkston Consulting (Clarkston).
Name ______________________________________________________________
Last (Please Print) First Middle

Present Address __________________________________________________________________________________

Number and Street City State Zip Code

Home Phone ______________________ Work Phone ____________________

Are you a U.S. citizen or Permanent Resident? Yes No If no, please state visa status _____________________________

EMPLOYMENT HISTORY List present or most recent first.

Employment Dates
Employer ____________________________________________________________________________
Address _____________________________________________________________________________ From / To /
Last Position _____________________________________ Supervisor ________________________ Final Annual Salary

May we contact the employer? Yes No Telephone

Employment Dates
Employer ____________________________________________________________________________
Address _____________________________________________________________________________ From / To /
Last Position _____________________________________ Supervisor ________________________ Final Annual Salary

May we contact the employer? Yes No Telephone

Employment Dates
Employer ____________________________________________________________________________
Address _____________________________________________________________________________ From / To /
Last Position _____________________________________ Supervisor ________________________ Final Annual Salary

May we contact the employer? Yes No Telephone

REFERENCES List three professional references.

Name

Telephone

Company

Title or Occupation

How long have you

known this person?
EDUCATION
Undergraduate Graduate
College/ University
City and State
Enrollment Start Graduation Date Enrollment Start Graduation Date
Enrollment and Graduation / / / /
Degree/ Major

BACKGROUND QUESTIONS
Yes No
Have you previously applied for a position with Clarkston? If yes, when? ____________________
Yes No Do you currently have any employment commitments with another company? If yes, explain in the comments section.

Yes No Are you presently subject to a Non-Disclosure or Non-Compete Agreement? If yes, explain in the comments section.

Yes No Are you willing to work on extended out-of-town assignments?

No Are you able to perform the essential functions of the job for which you are applying either without accommodation or with
Yes
a reasonable amount of accommodation? If you have special needs, please note in comments section below.

COMMENTS

EMERGENCY CONTACT List who should be contacted in the event of an emergency.

Name __________________________________________________________________________________________
Last First

Present Address __________________________________________________________________________________

Number and Street City State Zip Code

Home Phone Work Phone Relationship

I understand and agree that Clarkston may conduct a routine inquiry into my background to verify the above information.
All information contained in this application is true and correct to the best of my knowledge. I have not knowingly omitted any related information
and understand that any inaccurate or deliberately omitted information may make me ineligible for employment.
I acknowledge that any offer of employment extended by Clarkston is contingent on the execution of the company's standard confidentiality and
non-compete agreement.
Signature __________________________________________________ Date ____________________________

CLARKSTON CONSULTING IS AN EQUAL OPPORTUNITY EMPLOYER LAST REVISED: January 2019