Step 1 of 6 16% Thank you for your interest in employment with TLC Associates, Marshalltown. Please fill out the application below as completely as possible. We will be in touch with you as soon as we have had an opportunity to evaluate your qualifications. Application for Employment If you would like to be considered for employment, please fill out the application below. We will be in touch once we have your completed application on file.Full Name(Required) First Middle Last Email(Required) Primary Phone Number(Required)Available Start Date(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please Attach Your Cover Letter Here:Max. file size: 2 GB.Please Attach Your Resume Here:Max. file size: 2 GB. Employment History Please provide information on your most recent employer. If you have no employment history, simply enter “not applicable”.Title Company Name City, State Start Date of Employment (month and year) Last Date of Employment (month and year) Reason for leaving May we contact this employer? Yes No Second Most Recent Employer (NOTE: If you do not have any other employers to list, you may skip this page.)Title Company Name City, State Start Date of Employment (month and year) Last Date of Employment (month and year) Reason for leaving May we contact this employer? Yes No Next Most Recent Employer: (NOTE: If you do not have any other employers to list, you may skip this page.)Title Company Name City, State Start Date of Employment (month and year) Last Date of Employment (month and year) Reason for leaving May we contact this employer? Yes No Candidate Screening Please answer the following screening information:Are you looking for Full or Part-time employment?(Required) Full-TIme Part-Time Are you 18 years of age or older?(Required) YES NO Have you ever been employed at TLCA, either as a permanent employee or on a temporary basis through a staffing agency?(Required) YES NO If you are not a US citizen, does your visa or immigration status permit lawful employment?(Required) YES NO Please list the highest level of education that you have completed and/or any military experience.(Required) Applicant Affirmative Action Program Self Identification FormApplicant(Required) First Last Date of Application(Required) MM slash DD slash YYYY Position(s) for which you are applying(Required) Voluntary Information TLC Associates is a government contractor and to comply with the regulations for equal employment opportunity and affirmative action (EEO/AA), we must track our applicants by gender and race/ethnicity and the position they applied for to the government. We are an organization that values diversity and encourages women and minorities to apply. For this reason, we invite you to indicate your gender and race/ethnicity below. This information is kept separate from your application. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Responses will remain confidential within the Human Resources Department; and will be used only for the necessary information to include in our Affirmative Action Program and reporting requirements to the government. When reported, data will not identify any specific individuals.Gender(Required) Male Female Definitions of race/ethnicity are on the next page (as defined by the Equal Employment Opportunity Commission)Race/Ethnic Identification (check one)Are you Hispanic or Latino?(Required) Yes No If you answered “Yes” you have completed this form. If you answered “No” please select a race from the options below.Race 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) American Indian or Alaska Native (Not Hispanic or Latino) Two or More Races (Not Hispanic or Latino) I do not wish to disclose. Definitions of race/ethnic categories Hispanic of 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 maintain 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. Please select your referral source Facebook Job-Ad Instagram Job-Ad Online Ad TLCA Website Indeed Current Employee Referral If Current Employee Referral : Please Spell Out Full Name & position Sign and DateIMPORTANT:PLEASE READ THE FOLLOWING AND SIGN/DATE It is understood and agreed upon that any misrepresentation by me in the application or subsequent interview process will be sufficient cause for cancellation of this application and/or separation from the employer’s services if I have been employed. Furthermore, the electronic signature below authorizes the employer to conduct background checks related to any arrests or convictions that are a matter of public record. I give the employer the right to investigate all references and to secure additional job related information about me. I hereby release from any liability the employer and its representatives to seek such information and all other persons, corporations or organizations for furnishing such information. TLC & Associates is an Equal Opportunity Employer, and as such does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on any basis prohibited by local, state, or federal law. By indicating “yes” below, I acknowledge that I accept and agree to the terms of the employment statement above.I accept and agree to the terms of the employment statement above:YESNOFull Name (Note: this will serve as your electronic signature)(Required) Please date your application. (Note: application date must be entered to be considered valid.)(Required) MM slash DD slash YYYY DateCAPTCHA Δ
