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Personal Information
First name: *
Street address: *
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How did you hear about us?
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Additional Information
If you are an internal candidate please visit the Zoll LifeVest SharePoint Site and click on Internal Opportunities to view any internal postings.
Internal Candidate: *
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Yes
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Are you 18 yrs or older?: *
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Minimum Salary Desired: *
If not, do you have a work permit?
Work Permit:
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Have you ever used any other name(s) which is (are) necessary for us to know in order for us to verify your employment or educational record? If so, please list other names below.
Former Names:
Have you previously worked for or applied for a position with ZOLL Life Vest or with any of our divisions, either as an employee or through an employment agency?
Previously worked/applied: *
Please select
Yes
No
Using the space provided below if you indicated yes, please explain when and, if employed, in what capacity.
If yes, please indicate:
Do you have any relatives/friends now employed at ZOLL?
Relatives/Friends: *
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No
Using the space provided below please state name(s), relationship, and where they are located.
If yes, please specify:
Work Authorization: *
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I am authorized to work in this country for any employer
I am authorized to work in this country for my present employer only
I require sponsorship to work in this country
My status to work in this country is unknown
Highest Education Level: *
Please select
Associate's Degree
Bachelor's Degree
High School Diploma / GED
Master's Degree
Other
PhD
Trade or Technical School Diploma
Employment History: Please specify your complete full-time and part-time employment history, including self-employment. Begin with your most recent employer. :
Please explain any gaps in your employment in the space provided below.
Employment Gaps:
Education:
Certificates/Licenses:
Professional References: Please provided three (3) Professional References. Individuals not related to you.:
THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED AND ALL STATEMENTS BELOW HAVE BEEN READ AND SIGNED OFF ON.
I certify that all of the information furnished on this application and during the application process is true, complete, and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless or when the false answer or omissions are discovered.
I recognize that this application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice.
I further understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s), benefits and compensation rate(s) will be subject to change by ZOLL.
I understand that if I am offered employment, I may be required to sign a non-disclosure agreement, as a condition of the employment.
I understand that ZOLL may share the information contained in this application with other ZOLL employees for employment and administrative purposes and hereby consent to such transfer.
I hereby authorize ZOLL to conduct any necessary investigation regarding my background as it relates to the position I am seeking and to the extent permitted by federal, state, and local law. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection with the provision and use of such information.
I understand and expressly agree that if employed by ZOLL, storage areas provided for me (locker, desk, etc.) are open to investigation by ZOLL without prior notice to me.
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
I understand any offer of employment is contingent upon my producing documentation to verify my identity and US citizenship, or if an alien, my legal authorization to work in the United States, as required by federal law.
This concludes the application information.
Voluntary Equal Opportunity Questionnaire
As an equal opportunity employer, we hire without consideration to race, religion, color, national origin, age, gender, sexual orientation, gender identity, veteran status or disability. We invite you to complete the optional self-identification fields below used for compliance with government regulations and record-keeping guidelines.
Gender: *
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Female
Male
Choose Not to Disclose
Race: *
Please select
Hispanic or Latino
White (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
Asian (not Hispanic or Latino)
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Two or More Races (not Hispanic or Latino)
Choose Not to Disclose
Voluntary Veterans Status
This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002,38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:
A “disabled veteran ” is one of the following: 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 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 .
Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.
If you believe you belong to any of the categories of protected veterans listed above, please indicate by making the approprite selection below. As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. You can select all that apply by holding CTRL and clicking the approprite selections. Any information provided is voluntary and will not be not be used in any fashion that is inconsistent with this act.
Veteran/Disability: *
I am not a protected veteran
Disabled Veteran
Recently Separated Veteran
Active Wartime or Campaign Badge Veteran
Armed Forces Service Medal Veteran
I am a protected veteran, but choose not to self-identify by classification
Choose Not to Disclose
Voluntary cc305 Form
Candidate Individual with disabilities:
Voluntary Self-Identification of Disability Form CC-305 OMB Control Number 1250-0005 Expires 1/31/2020
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you 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 will not 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.
How do I know if I have a disability?
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 • Cerebral palsy • Multiple sclerosis (MS) • Deafness • HIV/AIDS • Missing limbs or partially missing limbs • Cancer • Schizophrenia • Post-traumatic stress disorder (PTSD) • Diabetes • Major depression • Obsessive compulsive disorder • Epilepsy • Bipolar disorder • Impairments requiring the use of a wheelchair • Autism • Muscular dystrophy • Intellectual disability (previously called mental retardation) Please Select one of the options below :
Please select
Yes, I have a disability (or previously had a disability)
No, I don't have a disability
I don't wish to answer
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.i 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 US. 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.