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Digital Marketing Associate
Sales Associate
Ophthalmic Technician
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bvision
2019-02-05T16:45:41-06:00
Job Application
Step 1 of 7
14%
EMPLOYMENT APPLICATION FORM
At Brinton Vision, we don’t just respect diversity — we thrive on it. We are proud to be an equal opportunity workplace.
Name
First
Last
Address
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What position are you applying for?
Digital Marketing Associate
Sales Associate
Ophthalmic Technician
What interests you about working at Brinton Vision?
Were you referred by a current Brinton Vision employee?
Yes
No
If yes, who?
Are you currently employed?
Yes
No
Are you looking for full time or part time employment?
Full Time
Part Time
Either
Days you are available to work?
No preference
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Based on the days you've indicated you are available to work, are there any times that you're unavailable? Please be specific.
When would you be able to start working at Brinton Vision?
Date Format: MM slash DD slash YYYY
Education
Did you graduate from high school?
Yes
No
When and where did you attend high school?
Did you attend college?
Yes
No
When and where did you attend college?
Did you graduate with a college degree or diploma?
Yes
No
College major
Did you attend graduate school?
Yes
No
When and where did you attend graduate school?
Did you graduate with a graduate degree or diploma?
Yes
No
Graduate degree attained/focus of studies
Other training/certifications
Employment History
Please include your last 3 jobs beginning with your most recent job held. Attaching a resume will not substitute for completing this section of the application.
Company Name
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Description of Duties
Final Wage/Salary
*
Final Position/Title
Reason For Leaving
Name of Supervisor
Supervisor's Phone Number
May we contact this employer?
Yes
No
Job 2:
Company Name
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Description of Duties
Final Wage/Salary
Final Position/Title
Reason For Leaving
Name of Supervisor
Supervisor's Phone Number
May we contact this employer?
Yes
No
Job 3:
Company Name
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Description of Duties
Final Wage/Salary
Final Position/Title
Reason For Leaving
Name of Supervisor
Supervisor's Phone Number
May we contact this employer?
Yes
No
Have you ever quit a job without giving two weeks' notice?
Yes
No
If yes, please explain:
Have you ever been involuntarily discharged from a job?
Yes
No
If yes, please explain:
Have you ever been convicted or pled guilty to a crime other than a minor traffic violation?
Yes
No
If so, please state crime, date, and place where offense occurred
Provide details of the above, including the nature of the offense and successful rehabilitation attempt(s) since the conviction
You are not required to disclose information about physical or mental limitations if you believe they will not interfere with your ability to do this job. However, if you want the employer to consider special arrangements to accommodate a physical or mental impairment, identify that impairment in the text box below and suggest the kind of accommodation that you believe would be appropriate.
I understand that the employer follows an “employment at will” policy, and that I or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by an Executive of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment. I understand this application will be active for a period of three months; after that time, if I wish to be considered for employment, I must submit a new application. I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information. I understand that my employment may be conditioned on successfully passing a background check. I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.
Signature
Today's Date
Date Format: MM slash DD slash YYYY
Upload Your Resume
Accepted file types: png, jpg, jpeg, doc, docx, pdf, txt, rtf, odf.
LinkedIn profile link
Step 1 of 7
14%
EMPLOYMENT APPLICATION FORM
At Brinton Vision, we don’t just respect diversity — we thrive on it. We are proud to be an equal opportunity workplace.
Name
First
Last
Address
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What position are you applying for?
Digital Marketing Associate
Sales Associate
Ophthalmic Technician
What interests you about working at Brinton Vision?
Were you referred by a current Brinton Vision employee?
Yes
No
If yes, who?
Are you currently employed?
Yes
No
Are you looking for full time or part time employment?
Full Time
Part Time
Either
Days you are available to work?
No preference
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Based on the days you've indicated you are available to work, are there any times that you're unavailable? Please be specific.
When would you be able to start working at Brinton Vision?
Date Format: MM slash DD slash YYYY
Education
Did you graduate from high school?
Yes
No
When and where did you attend high school?
Did you attend college?
Yes
No
When and where did you attend college?
Did you graduate with a college degree or diploma?
Yes
No
College major
Did you attend graduate school?
Yes
No
When and where did you attend graduate school?
Did you graduate with a graduate degree or diploma?
Yes
No
Graduate degree attained/focus of studies
Other training/certifications
Employment History
Please include your last 3 jobs beginning with your most recent job held. Attaching a resume will not substitute for completing this section of the application.
Company Name
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Description of Duties
Final Wage/Salary
*
Final Position/Title
Reason For Leaving
Name of Supervisor
Supervisor's Phone Number
May we contact this employer?
Yes
No
Job 2:
Company Name
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Description of Duties
Final Wage/Salary
Final Position/Title
Reason For Leaving
Name of Supervisor
Supervisor's Phone Number
May we contact this employer?
Yes
No
Job 3:
Company Name
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Description of Duties
Final Wage/Salary
Final Position/Title
Reason For Leaving
Name of Supervisor
Supervisor's Phone Number
May we contact this employer?
Yes
No
Have you ever quit a job without giving two weeks' notice?
Yes
No
If yes, please explain:
Have you ever been involuntarily discharged from a job?
Yes
No
If yes, please explain:
Have you ever been convicted or pled guilty to a crime other than a minor traffic violation?
Yes
No
If so, please state crime, date, and place where offense occurred
Provide details of the above, including the nature of the offense and successful rehabilitation attempt(s) since the conviction
You are not required to disclose information about physical or mental limitations if you believe they will not interfere with your ability to do this job. However, if you want the employer to consider special arrangements to accommodate a physical or mental impairment, identify that impairment in the text box below and suggest the kind of accommodation that you believe would be appropriate.
I understand that the employer follows an “employment at will” policy, and that I or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by an Executive of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment. I understand this application will be active for a period of three months; after that time, if I wish to be considered for employment, I must submit a new application. I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information. I understand that my employment may be conditioned on successfully passing a background check. I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.
Signature
Today's Date
Date Format: MM slash DD slash YYYY
Upload Your Resume
Accepted file types: png, jpg, jpeg, doc, docx, pdf, txt, rtf, odf.
LinkedIn profile link
