On-line Application for Employment

Tichenor & Associates, LLP

Tichenor and Associates, LLP is an equal employment opportunity employer. All qualified applicants will be considered without regard to race, color, religion, sex, national origin, physical or mental disability, special disabled veteran status, status as a veterans of the Vietnam era, or other protected class.

PERSONAL INFORMATION

Date:  Position applied for:  F/T  P/T
Name:     
Address (Street, City, State, Zip): 
Phone:     SS Number: 
email Address: 
Friends/Relatives employed byTichenor& Associates: 
Date Available: Salary Desired: 
Emergency Contact: 

EDUCATION

Level Name & Address of School Years Attended Diploma or Degree
High School
College
Other
 CPA Certificate: yes   no         State of CPA: 
 Certificate No.:   Date Issued: 


EMPLOYMENT
List all of your employers over the last 15 years, beginning with the most recent employer.

Company:  Address: 
Dates of Employment:  Salary:   Starting:  $;    Ending:  $
Duties:  

Reason for leaving:  

 
Company:  Address: 
Dates of Employment:  Salary:   Starting:  $;    Ending:  $
Duties:  
Reason for leaving:  
 
Company:  Address: 
Dates of Employment:  Salary:   Starting:  $;    Ending:  $
Duties:  
Reason for leaving:  


REFERENCES
Give the name, occupation, address and phone number of 3 persons, not related to you, to whom we may refer.

Name & Occupation Address Phone Number


REMARKS
Give any additional information which may be of interest in considering your qualifications.

Acknowledgments and Arbitration Agreement

The information in my application for employment is true and complete. As part of the hiring process, I acknowledge that I may be required to submit to a medical examination, including a drug/alcohol screen. I may also be required to execute forms to facilitate background checks. I authorize Tichenor & Associates, LLP to contact my references and former employers. I release my references and former employers from any and all liability in connection with providing information to Tichenor & Associates, LLP. If I become a Tichenor & Associates, LLP employee, I understand that any and all employment-related legal disputes, including but not limited to discrimination and other wrongful employment practice claims, between myself and Tichenor & Associates, LLP will be resolved through final, mandatory, and binding arbitration, with the exception of workers´┐Ż compensation, unemployment compensation, unfair competition/trade secret claims, breach of confidentiality, and any restrictive covenant claims. Tichenor & Associates, LLP will bear the costs of the arbitrator, court reports for the arbitration hearing, and American Arbitration Association fees. The arbitration will be governed by the employment dispute resolution rules of the American Arbitration Association, except as otherwise mutually agreed to by the parties;

The submission of the above information constitutes my electronic signature.  Check here to comply.

               


©2017  Tichenor & Associates, LLP
1700 Eastpoint Parkway, Suite 270, Louisville, KY 40223  Phone: 502.245.0775