* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon engagement):

Yes   No

* Will you now or in the future require CE Wilson Consulting to commence an immigration case in order to employ you (for example, H-1B or other employment-based immigration cases)?:

Yes   No

* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):

Yes   No

* Have you ever been convicted of a felony or a misdemeanor which resulted in imprisonment within the last seven years?:

Yes   No

If Yes, please explain:

* Have you ever performed work with or for CE Wilson Consulting?:

Yes   No

If Yes, please provide details (Where/When/Job Title):

* Are you able to perform the essential functions of the job for which you are applying?:

Yes   No

If no, please explain:

* When are you available to begin work?:

* Please affirm your understanding that this an Independent Contractor role.:

Yes, I understand this is an Independent Contractor role No, I do not wish to apply for an Independent Contractor role

* Hourly rate desired:

* Are you currently employed?:

Yes   No

If so may we inquire of your present employer?:

Yes   No

If presently employed, why are you considering leaving?:

* Are you available or do you plan to be available for hybrid on-site/remote engagements in the Greater Phoenix, AZ area?:

Yes, I am available or plan to be available for hybrid, on-site/remote engagement in the Greater Phoenix, AZ area. No, I am only available for remote engagements.

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location	Did you Graduate?	Degree Received	Subjects Studied/Major
	Yes   No
	Yes   No
	Yes   No

Give your full employment record, starting with your current or most recent employment

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

Dates Employed	Employer Name & Address	Employer Phone
From: To:
Job Title	Supervisor Name & Title	May we Contact?
		Yes No
Responsibilities	Reason for Leaving	Salary/Hourly Rate
		Start: End:

Name	Relationship	Phone Number	Email

The facts set forth in this application and any supplemental information are true and complete to the best of my knowledge. I understand that, if hired, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for hire establishes any obligation for the company to hire me. If I am hired, terms of the engagement will be reflected in the consulting contract. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

* Signature (type name):

* Date: