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WEIGHT REDUCTION CAPABILITIES

Fulcrum Concepts, LLC Application for Employment

Fulcrum Concepts, LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law.

APPLICANT INFORMATION
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
EMPLOYMENT POSITION
Position(s) applying for*
How did you hear about this position?*
On what date can you start working if you are hired?*
Salary desired*
PERSONAL INFORMATION
Have you ever applied to or worked for Fulcrum Concepts, LLC before?*
- Yes
- No
If yes, when?
Do you have any friends, relatives, or acquaintances working for Fulcrum Concepts, LLC?*
- Yes
- No
If yes, state name & relationship.
Are you a U.S. citizen or approved to work in the United States?*
- Yes
- No
What document can you provide as proof of citizenship or legal status?

For example: U.S. passport, Birth Certificate, Certificate of Naturalization or Certificate of Citizenship.
Will you consent to a mandatory controlled substance test?*
- Yes
- No
Do you have any condition which would require job accommodations?*
- Yes
- No
If yes, please describe accommodations required below.
Do you currently possess an active security clearance?*
- Yes
- No
As a requirement of employment at Fulcrum Concepts, LLC, you may be required to apply for a security clearance. By submitting this application, you verify acknowledgement of this requirement.
JOB SKILLS/QUALIFICATIONS
(Note: Fulcrum Concepts, LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)
Please list below the skills and qualifications you possess for the position for which you are applying:*
EDUCATION AND TRAINING
Do you have a High School Diploma?*
- Yes
- No
High School
Name
Location

City and State
Year Graduated
Degree Earned
GED Education Verification
GED verifications go through the Department of Education in the state where the applicant obtained the GED. To verify a GED, an applicant’s date of birth, name used when the GED was obtained, and the date they obtained the GED (at least the year) is needed.
Do you have a GED?
- Yes
- No
On what date did you obtain your GED?
In what state did you obtain your GED?
What is your date of birth?
College/University
Do you have any College/University Education?*
- Yes
- No
Name
Location

City and State
Year Graduated
Degree Earned
Do you need to list any additional College/University Education?
- Yes
- No
Name
Location

City and State
Year Graduated
Degree Earned
Do you need to list any additional College/University Education?
- Yes
- No
Name
Location

City and State
Year Graduated
Degree Earned
Vocational School/Specialized Training
Do you have any Vocational School/Specialized Training*
- Yes
- No
Name
Location

City and State
Year Graduated
Degree Earned
Do you need to list any additional Vocational School/Specialized Training
- Yes
- No
Name
Location

City and State
Year Graduated
Degree Earned
Do you need to list any additional Vocational School/Specialized Training
- Yes
- No
Name
Location

City and State
Year Graduated
Degree Earned
Military Experience
Are you or have you been a member of the Armed Services?*
- Yes
- No
In which branch of the military did you serve?
What was your military rank when discharged?
How many years did you serve in the military?
What military skills do you possess that would be an asset for this position?
EMPLOYMENT HISTORY
Starting with your most recent, describe all paid, military and applicable voluntary experience. Highlight your knowledge, skills, and abilities which best demonstrate your qualifications for this position.
Employer Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Dates Employed
Duties
Reason for Leaving
May we contact your present supervisor?
- Yes
- No
Supervisor Name
First Last
Supervisor Phone
Supervisor Email
Do you have additional employment to list?
- Yes
- No
Employer Name
Supervisor Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Dates Employed
Duties
Reason for leaving
Do you have additional employment to list?
- Yes
- No
Employer Name
Supervisor Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Dates Employed
Duties
Reason for leaving
REFERENCES
Please provide 3 professional and/or personal reference(s) below:
Professional References*
Name Title Company Professional relationship? (Supervisor, Colleague, Client, Professor, etc.) How long have you known the reference? Email Phone Number

(Click on the plus symbol to add additional professional references.)
Personal References*
Name Email Phone Number

(Click on the plus symbol to add additional personal references.)
VOLUNTARY INFORMATION
As a government contractor, we are required to report certain data regarding our applicants and employees to the government. Submission of this information is voluntary.
Self Identification Forms
Please open the links below using Adobe Acrobat to fill out the forms and submit them.

NOTE: The "Submit Form to HR" button in the pdf's will not work if you do not have a default email client set up. Alternative Options: (1) Save the form(s) to your computer and upload them below. (2) Save the form(s) and email attachments to hr@fulcrumconceptsllc.com.

Veteran Self Identification

Race and Gender Self Identification

Self Identification of Disability
File Uploads
Uploads limited to .pdf files, max file size of 2MB
Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 3.
Additional Information
Please include any additional information you would like to share regarding your qualifications or why you feel you would be a good fit with Fulcrum Concepts, LLC.
RESUME - COVER LETTER - TRANSCRIPTS
File Uploads
Please upload your Resume, a Cover Letter, and any transcripts. (Uploads limited to .pdf files, max file size of 2MB)
Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 3.
CERTIFICATION
CONSENT FOR RELEASE OF INFORMATION*
I hereby certify that all entries on this form and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment at Fulcrum Concepts, LLC. I understand all information on this application is subject to verification, and I consent to criminal history background checks. I also consent that you may contact references, former employers, and educational institutions listed regarding this application. I further authorize Fulcrum Concepts, LLC to rely upon and use, as it sees fit, any information received from such contacts.
Name
First Last
Date
Month
Day
Year
Captcha
Attention Applicants
After you click the SUBMIT button, you will see a notification that your application has successfully been submitted. If no notification is received, please check your application for any error messages or missing required fields. Thank you.

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Experience the Fulcrum Advantage

Fulcrum Concepts, LLC Application for Employment

APPLICANT INFORMATION

EMPLOYMENT POSITION

PERSONAL INFORMATION

JOB SKILLS/QUALIFICATIONS

EDUCATION AND TRAINING

High School

GED Education Verification

College/University

Vocational School/Specialized Training

Military Experience

EMPLOYMENT HISTORY

REFERENCES

VOLUNTARY INFORMATION

RESUME - COVER LETTER - TRANSCRIPTS

CERTIFICATION

Attention Applicants

About Fulcrum Concepts

Contact Fulcrum Concepts

Proud to be Members

Name	Title	Company	Professional relationship? (Supervisor, Colleague, Client, Professor, etc.)	How long have you known the reference?	Email	Phone Number