Akeela Application for Employment

Step 1 of 6

16%

Position applying for

You are seeking

Full-Time

Part-Time

On-call

Temporary

Program applying for

Location

How did you hear about the position?

Referred by:

Why do you want to work for Akeela?

CONTACT INFORMATION

Name(Required)

First Last AKA/Alias Name(s)

Home Phone(Required)

Other Phone

Email(Required)

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physical Address (If different from mailing)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BACKGROUND

Have you filed an application with Akeela before?

Yes

If yes, date

MM slash DD slash YYYY

Have you ever been employed with Akeela before?

Yes

If yes, year(s)

Are there any days of the week you will be unable to work?

Yes

If yes, please indicate day(s) you are UNABLE to work

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Have you ever been charged or convicted of a crime, other than a minor traffic violation?

Yes

No applicant will be denied employment solely on the grounds of a conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however be considered.

If yes, please explain

EDUCATION, SKILLS, AND CERTIFICATIONS

High School

City

State

Did you graduate?

Yes

Last year completed

Certificate attained

Diploma

GED

College/University #1

College/University

City

State

Did you graduate?

Yes

Last year completed

Course(s) of study

Degree(s) attained

College/University #2

College/University

City

State

Did you graduate?

Yes

Last year completed

Course(s) of study

Degree(s) attained

ADDITIONAL EDUCATION, LICENSES, CERTIFICATIONS

Additional degrees/education

Professional license/certification

Expiration date if applicable

Professional license/certification

Expiration date if applicable

Professional license/certification

Expiration date if applicable

Additional professional affiliations

please list

Do you have any negative actions, past or pending, on any licenses or certifications?

Yes

If yes, please explain

Additional skills and qualifications

Please list

EMPLOYMENT HISTORY

Please begin with most current position.

Employer #1

Employer

Title held

Annual salary

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor Name

First Last

Supervisor phone

Supervisor email

List duties

Reason for leaving

My Akeela contact?

Yes

Employer #2

Employer

Title held

Annual salary

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor Name

First Last

Supervisor phone

Supervisor email

List duties

Reason for leaving

May Akeela Contact?

Yes

Employer #3

Employer

Title held

Annual salary

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Employer address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor name

First Last

Supervisor phone

Supervisor email

List duties

Reason for leaving

May Akeela contact?

Yes

REFERENCES

Reference #1

Reference name

First Last

Phone

Relationship

How long?

Reference #2

Reference name

First Last

Phone

Relationship

How long?

Reference #3

Reference name

First Last

Phone

Relationship

How long?

AKEELA POLICIES AND APPLICANT AGREEMENTS

By checking the boxes below, applicant is hereby signing this document.

Consent(Required)

I agree to the tobacco policy.

Akeela, Inc. does not permit the use of tobacco related products in the workplace.

Consent(Required)

I have read and fully understand the statement(s) below.

• I understand that if I am employed, any misrepresentation made by me on this application will be sufficient cause for cancellation of this application or immediate discharge from employment by Akeela Inc., whenever it is discovered.

• I give Akeela Inc. the right to contact and obtain information from all references, employers, educational institutions, and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability Akeela, Inc. and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information

• This application is current only for the position noted on first page. When the position is filled, if I have not heard from Akeela Inc. and still wish to be considered for employment, it will be necessary to fill out a new application.

• I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization

• If the position applied for requires driving in the course of work, I understand that I will be required to possess a current and valid AK driver’s license and understand that I will be required to provide a copy of my official driving record and proof of insurance. I also understand that any offer of employment is contingent on my ability to be covered by Akeela Inc. auto insurance, if required for my position.

• This employment offer is not an employment contract and is not intended to create contractual obligations of any kind. Our employment relationship will be terminable at will, which means that either you or Akeela Inc. may terminate your employment at any time and for any reason or for no reason with or without notice.

Consent(Required)

I agree to the discrimination policy stated below.

It is the policy of Akeela Inc. to initiate comprehensive affirmative action personnel programs in order to provide applicants and employees the right to equal employment opportunities. Akeela, Inc. will not engage in discriminatory practices against any person employed or seeking employment because of race, color, religion, ethnic background, national origin, marital status, physical or mental handicaps, veteran status or sexual preference or within the limits imposed by law because of age or citizenship.

Upload resume and/or cover letter

Max. file size: 100 MB.

SELF-REPORTING DATA SHEET

Akeela, Inc. treats employees and applicants for employment on the basis of merit and experience, without regard to race, color, religion, sex, national origin, physical or mental disability, marital status, changes in marital status, pregnancy, parenthood or age. In an effort to evaluate our selection process and to meet government reporting requirements we request that you complete this form. The data you provide is to be used solely for reporting, research, statistical purposes and to comply and monitor compliance with legal requirements. Your voluntary cooperation will be appreciated and failure to complete this form will not affect the decision concerning your employment application.

Name

First Last

Date

MM slash DD slash YYYY

Position applying for

Age

Gender

Male

Female

Other

Race

Hispanic or Latino

Alaska Native

White

Black or African American

Native Hawaiian or Pacific Islander

Asian

American Indian

Other

Please select all that apply.

Akeela Application for Employment

CONTACT INFORMATION

BACKGROUND

EDUCATION, SKILLS, AND CERTIFICATIONS

High School

College/University #1

College/University #2

ADDITIONAL EDUCATION, LICENSES, CERTIFICATIONS

EMPLOYMENT HISTORY

Employer #1

Employer #2

Employer #3

REFERENCES

Reference #1

Reference #2

Reference #3

AKEELA POLICIES AND APPLICANT AGREEMENTS

SELF-REPORTING DATA SHEET

Contact Us

Call us
1-800-478-7738

Visit us
360 West Benson, Suite 300
Anchorage, Alaska 99503

Links

Akeela Application for Employment

CONTACT INFORMATION

BACKGROUND

EDUCATION, SKILLS, AND CERTIFICATIONS

High School

College/University #1

College/University #2

ADDITIONAL EDUCATION, LICENSES, CERTIFICATIONS

EMPLOYMENT HISTORY

Employer #1

Employer #2

Employer #3

REFERENCES

Reference #1

Reference #2

Reference #3

AKEELA POLICIES AND APPLICANT AGREEMENTS

SELF-REPORTING DATA SHEET

Contact Us

Call us 1-800-478-7738

Visit us 360 West Benson, Suite 300 Anchorage, Alaska 99503

Links

Call us
1-800-478-7738

Visit us
360 West Benson, Suite 300
Anchorage, Alaska 99503