Application for Employment

At Bergeron, it’s our people that make us an exceptional partner for our clients. We’re always interested in qualified, highly motivated professionals who share our commitment to integrity and accountability.

You can apply online by completing the form below.

Step 1 of 3

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Referral Source

Please check the appropriate category and list the referral source below.
From ___/___/___ To ___/___/___
If yes, additional information may be requested.
If yes, additional information may be requested.
$________________________________ Per _________________________________
This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Driver's license number required if driving may be required in the job for which you are applying:

Answering "yes" to either of the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account.

NOTE: You are not obligated to disclosed sealed or expunged records of conviction or arrest.

Employment History

Starting with your most recent employer, provide the following information:
From Month/Year to Month/Year
$______________ Per __________
$______________ Per __________



Employer #2

From Month/Year to Month/Year
$______________ Per __________
$______________ Per __________



Employer #3

From Month/Year to Month/Year
From Month/Year to Month/Year
$______________ Per __________
$______________ Per __________



Employer #4

$______________ Per __________
$______________ Per __________



Skills and Qualifications




Computer Skills

Check appropriate boxes. Include software titles and years of experience.




Educational Background

Starting with your most recent school attended, provide the following information:




School #2




School #3




School #4




References

List names and telephone numbers of three business/work references who are not related to you and are notprevious supervisors. If not applicable, list three school or personal references who are not related to you.




Reference #2




Reference #3




Social Security Number

We will use this information only for employment purposes and make reasonable efforts to safeguard your privacy.

______-____-_______


Related Information

To what job-related organizations (professional, trade, etc.) do you belong?


Exclude memberships that would reveal race, color, religion, sex, national origin, genetic information, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
Exclude information that would reveal race, color, religion, sex, national origin, genetic information, citizenship, age, mental or physical disabilities, veteran/ reserve national guard or any other similarly protected status.


Applicant Statement



I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.



I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional),employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents. employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.



I understand that this employer does not unlawfully discriminate in employment and noquestion on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.



I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.



If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.



I understand that if I am hired, my employment will be subject to a probationary period, which ordinarily will not exceed 90 days from the date I am hired. IO am discharged at anytime during the probationary period for unsatisfactory performance, I understand that this employer will not be charged for any unemployment benefits that may be paid to me for work I performed during the probationary period.


I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an 1-9 Form in this regard.



This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status un der applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.



I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i} eliminate me from further consideration for employment, or (ii} may result in my immediate discharge from the employer's service, whenever it is discovered.



DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.



I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Clear Signature

Reaffirmation of Affirmative ActionPolicy Statement

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