Gwinnett Vendor Information Submission

Step 1 of 4 - Personal Details

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Personal Details

Position Applying For

Full Legal Name:*

Your Email Address:*

Today's Date:*

MM slash DD slash YYYY

Your Phone Number:*

Are you 18 years of age or older?*

Yes

Are you legally authorized to work in the U.S.?*

Yes

Have you ever worked or attended school under another name? If so, under what name?

When are you available to start working?

Desired hours per week:

Hours of the day you are available to work:

e.g. 8am to 5pm

Salary desired

Days of the week you are available to work:

e.g. Monday through Friday

Have you ever been CONVICTED of a felony?*

Yes

If Yes, please detail:*

e.g. felony committed, year convicted, sentence, etc.

Have you ever worked for Partnership Gwinnett or the Gwinnett Chamber of Commerce?*

Yes

If yes, dates of employment:*

e.g. From April 2010 to December 2015

Reason for leaving your job at Partnership Gwinnett or the Gwinnett Chamber:

How did you learn about this job opening?*

If Referral or Other, please indicate:*

Highest level of education attended:*

Did you graduate/earn your degree?*

Yes

Please list any other education, training or special skills you have that will benefit you in this job:

Work Experience

Please list all previous employment, beginning with the most recent. If you need more room, you may attach another sheet of paper.

Employer

Employer's Address:

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

Duration of Employment:

e.g. March 2010 to July 2015

Position Held:

Description of Duties:

Reason for Leaving This Job:

Supervisor's Name & Title:

May We Contact This Employer?

Yes

Starting Compensation (per year):

Ending Compensation (per year):

Employer 2

Add Another Employer

Employer

Employer's Address:

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

Duration of Employment:

e.g. March 2010 to July 2015

Position Held:

Description of Duties:

Reason for Leaving This Job:

Supervisor's Name & Title:

May We Contact This Employer?

Yes

Starting Compensation (per year):

Ending Compensation (per year):

Employer 3

Add Another Employer

Employer

Employer's Address:

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

Duration of Employment:

e.g. March 2010 to July 2015

Position Held:

Description of Duties:

Reason for Leaving This Job:

Supervisor's Name & Title:

May We Contact This Employer?

Yes

Starting Compensation (per year):

Ending Compensation (per year):

Employer 4

Add Another Employer

Employer

Employer's Address:

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

Duration of Employment:

e.g. March 2010 to July 2015

Position Held:

Description of Duties:

Reason for Leaving This Job:

Supervisor's Name & Title:

May We Contact This Employer?

Yes

Starting Compensation (per year):

Ending Compensation (per year):

References

Identify three persons who know your work, beginning with the most recent.

Name of First Reference:

Phone Number of First Reference:

Email of First Reference:

Address of First Reference:

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

Position/Title of First Reference:

Years That You Have Known the First Reference:

Reference 2

Add Another Reference

Name of Second Reference:

Phone Number of Second Reference:

Email of Second Reference:

Address of Second Reference:

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

Position/Title of Second Reference:

Years That You Have Known the Second Reference:

Reference 3

Add Another Reference

Name of Third Reference:

Phone Number of Third Reference:

Email of Third Reference:

Address of Third Reference:

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

Position/Title of Third Reference:

Years That You Have Known the third Reference:

Authorization and Acknowledgements

I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the Gwinnett Chamber, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure. I understand that if offered employment with the Gwinnett Chamber of Commerce, all employment is contingent on the successful completion of a drug screen and background check.

I Authorize and Acknowledge the Above Statement:*

Yes

Attach Your Resume Here:*

Max. file size: 200 MB.

Attach Your Cover Letter Here:

Max. file size: 200 MB.

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Personal Details

Work Experience

References

Authorization and Acknowledgements

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Research Manager

Personal Details

Work Experience

References

Authorization and Acknowledgements