	Employment Application

* = Required	For help with this application form - contact jobs@srfconsulting.com
	Part 1: Position
*Position:
Position Type/Area of Interest (optional):
*Referral Source:
Referral Details:

	Part 2: Resume
	Use the following buttons to include electronic versions of your resume and cover letter.
Resume (Word/PDF):
Cover Letter (Word/PDF):
Other File (Word/PDF):

Paste text copy of resume: (4000 character limit):
References name/phone: (1000 character limit):

	Part 3: Personal Information
*First Name:
*Middle Initial:
*Last Name:
*Street Address:
*City:
*State:
*Zip Code:
*Phone (xxx-xxx-xxxx):
*Email Address:

	Part 4: Professional Information
	Work Experience List your last three positions held, starting with the most recent. Employer #1
Present/Previous Employer:
City:
State:
Phone (xxx-xxx-xxxx):
Position Title:
Supervisor:
Responsibilities: (500 character limit)
Employment Start Date:
Employment End Date:
Reason for Leaving:
Starting Yearly Salary:
Ending Yearly Salary:
	Employer #2
Present/Previous Employer:
City:
State:
Phone (xxx-xxx-xxxx):
Position:
Supervisor:
Responsibilities: (500 character limit)
Employment Start Date:
Employment End Date:
Reason for Leaving:
Starting Yearly Salary:
Ending Yearly Salary:
	Employer #3
Present/Previous Employer:
City:
State:
Phone (xxx-xxx-xxxx):
Position:
Supervisor:
Responsibilities: (500 character limit)
Employment Start Date:
Employment End Date:
Reason for Leaving:
Starting Yearly Salary:
Ending Yearly Salary:

	Education / Training
High School:
Did You Graduate?	YesNo
College #1:
What type of Degree?
Course of Study:
Did You Graduate?	YesNo
College #2:
What type of Degree?
Course of Study:
Did You Graduate?	YesNo
*If applicable, do you have the required license, registration and / or certification(s) for this position?	YesNoNot Applicable
	List other additional skills, training, certifications, and education that qualifies you for the position of interest.
Additional Skills/Training: (500 character limit)

	Employment Questions
*May we contact your present employer?	YesNo
*Are you currently eligible to work in the United States?	YesNo
*Do you now or will you in the future require employer visa sponsorship?	YesNo
*Desired Wage or Salary Range:
*Employment Preference	Full-TimePart-Time If part-time, are there any times or dates you cannot or will not work?

*On what date are you available for work:
*Have you worked for SRF Consulting before?	YesNo
	If Yes, please provide the following information:
	Employment Start Date:
	Employment End Date:
*Are you on a lay-off and subject to recall?	YesNo
*Can you travel if a job requires it?	YesNo

Part 5: Equal Employment Opportunity Information

SRF Consulting Group, Inc. is subject to affirmative action and nondiscrimination recordkeeping and reporting requirements which requires us to invite all candidates to voluntarily self-identify their race/ethnicity, gender, veteran status and disability status. The following requested information is voluntary and confidential. Information provided will be used solely for affirmative action purposes and will not be a part of your official application for employment. Information you provide will not be used for interview purposes and choosing not to answer will not subject you to any adverse action.

SRF seeks to reach out to, hire, and provide equal opportunity to qualified individuals who identify with these protected categories. By providing this information you help us measure how we are doing in these efforts. Categories available below are determined by applicable laws and regulations.

Gender:

(please check one)
Female
Male
Non-Binary

Race:

(please check one of the descriptions below corresponding to the ethnic group with which you identify)
Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
Asian (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America) and who maintains a tribal affiliation or community attachment.
Two or more races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.
I do not wish to answer.

Veteran Status:

Check if any of the following are applicable:

Disabled Veteran – A veteran of the U.S. Military, ground, naval or air service who is 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.

Recently Separated Veteran – A 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.

Active Wartime or Campaign Badge Veteran – 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.

Armed Forces Service Medal Veteran – A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a U.S. military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

I am a protected veteran, but I choose not to self-identify the classifications to which I belong.

I am NOT a protected veteran.

Disability Status:

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:

Autism
Autoimmune disorder (examples: lupus, fibromyalgia, rheumatoid arthritis, or HIV/AIDS)
Blind or low vision
Cancer
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or hard of hearing
Depression or anxiety
Diabetes
Epilepsy
Gastrointestinal disorder (examples: Crohn’s Disease, or irritable bowel syndrome)
Intellectual disability
Missing limbs or partially missing limbs
Nervous system condition (examples: migraine headaches, Parkinson’s disease, or Multiple sclerosis (MS))
Psychiatric condition (examples: bipolar disorder, schizophrenia, PTSD, or major depression)

Please check one of the boxes below:
Yes, I have a disability, or a history/record of having a disability.
No, I don't have a disability, or a history/record of having a disability.
I do not wish to answer.

	Part 6: Signature and Submit Application
	By typing in your complete name, you are indicating that all of the information submitted by you is complete and true to your knowledge and that you have read and understand the information on this page. I authorize investigation of all statements contained in this application for employment. I understand that this application is not and is not intended to be a contract of employment.In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. SRF Consulting Group Inc., in considering my application for employment, may verify the information set forth on this application and obtain additional background check information relating to my background. I understand that an offer of employment with SRF will be contingent on the receipt and evaluation of the background check.
*Signature:	*Date:

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