Brookwoods Group Quick Application

Quick Employment Application

Your data in this form is automatically saved as you type until you press SUBMIT. If the form is not submitted, you can come back to the form later on (for up to 60 days) and continue where you left off.

REQUIRED fields are marked with a red asterisk. Be sure to press SUBMIT when you are done.

Brookwoods Group is an Equal Opportunity Employer and does not discriminate as to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Contact Information

First Name[required]

Middle Name

Last Name[required]

Suffix[Jr MD III etc]

Maiden Nameor former name

Best Email[required]

Permanent ADDRESS (street number, street, unit number)[required]

Permanent CITY[required]

Permanent STATE[required]

Permanent ZIP[required]

Personal Mobile or Cell PHONE[required]

Important Information

You may identify me as a candidate. I agree that Brookwoods Group may use my name, likeness, and any information about me in developing proposals to clients. Brookwoods Group has my permission to act as my non-exclusive agent in the following business opportunities: Consulting, Staffing, Contracting, Recruiting, and Outsourcing. I agree that information about me may be contained in Brookwoods Group proposals and shared with other parties with whom Brookwoods Group has or is attempting to form a professional relationship.[required]

YesNo

I will keep information confidential. Any information provided to me by Brookwoods Group about specific employment opportunities will be treated as CONFIDENTIAL by me and I will not share such information without specific permission, approach the named Brookwoods Group client(s) on my own without specific permission, or take any material actions based on this information without specific permission.[required]

YesNo

Base Compensation RANGE: My MINIMUM or most recent full time ANNUAL BASE SALARY or HOURLY PAY, not counting bonuses, commissions, unusual perks, etc., is:

Base Compensation RANGE: Given my talent, skills, knowledge, experience, reputation, and history, this is my DESIRED ANNUAL BASE SALARY or HOURLY PAY:

Last FIVE digits of Social Security Number[required]

Social Security Numbers: Please note that this application for Brookwoods Group does not require your entire social security number. If we need to check on your background at any time, you will provide your social security number in confidence directly to our independent background screening provider and they do not provide the entire number back to us. We do not use your social security number to run a credit check.

Validation

Signature. I affirm that all information is correct and true.[required]

(Sign here with mouse, finger or stylus)

clear signature

Date of Signature[required]