Age Verification

Are you 18 years of age or older?
Yes
No
Are you 16 years of age or older?
Yes
No

Personal Information
First Name Middle Name Last Name
Street Address Apt #:
City State Zip
Phone - -
Email

Eligibility
Are you legally authorized to work in the United States?
Yes, I am legally authorized to work in the United States
No, I am not legally authorized to work in the United States

If hired, are you able to provide proof of legal eligibility to work in the United States?
Yes, I am able to provide proof of legal eligibility to work in the United States
No, I am not able to provide proof of legal eligibility to work in the United States

Position Information
First Date Available to Work
How did you hear about this position
Names of people you know on our staff?
Have you applied and been interviewed here before? Yes No
Month and year
Have you worked at any Venture Data location before? Yes No

Start Date End Date
Reason for leaving
What is the best time to reach you?

Skills
You must have some typing experience in order to perform this job.
Have you previously had a job where you used a computer? Yes No
How many words per minute can you type? WPM
Do you have have previous telephone work experience? Yes No
Are you fluent in a foreign language? Yes No
Foreign language spoken: Spanish Other
Are you a native Spanish speaker? Yes No
Please describe your knowledge and experience with the Spanish language.

Are you equally fluent in speaking both Engilsh and Spanish? Yes No
Are you equally fluent in reading both English and Spanish? Yes No
How often do you use a computer?
What do you use it for?
Do you have experience reading from unfamiliar scripts? Yes No
Describe briefly:
Do you know what 'verbatim' means? Yes No
Provide brief definintion:

Scheduling Requirements
Hours of operation:
Monday - Thursday 3:00 PM to 10:00 PM
Sunday 11:00 AM to 7:00 PM Monday - Friday 1:00 PM to 10:00 PM
Saturday & Sunday 10:00 AM to 7:00 PM Monday - Friday 4:00 PM to 12:00 AM
Saturday & Sunday 1:00 PM to 9:00 PM Saturday & Sunday 11:00 AM to 7:00 PM
Monday - Friday 3:00 PM to 10:00 PM
All employees must be available a minimum of 24 20 24 22 hours per week
Can you meet these scheduling requirements? Yes No
Explain:
How many hours per week do you prefer to work?
Do you have reliable transportation to and from work? Yes No
Explain

Education
Are you currently enrolled in school? Yes No
What time does your last class of the day end?

	Name and address of school	Area Of Study	Graduated	Years Completed
High School			Yes No
College			Yes No
Other Education			Yes No

List any volunteer work, work study, or extracurricular activities you have done:

Employment History
Start with the most recent first.
Are you currently employed? Yes No

Current or Last Employer
Dates Employed to
Address
Your Job Title Supervisor Phone - -
Describe your duties
Reason for leaving   
May we contact this employer? Yes No

Employer
Dates Employed to
Address
Your Job Title Supervisor Phone - -
Describe your duties
Reason for leaving   
May we contact this employer? Yes No

Employer
Dates Employed to
Address
Your Job Title Supervisor Phone - -
Describe your duties
Reason for leaving   
May we contact this employer? Yes No

Personal References
Please provide two personal/professional references:
Name: Phone: - -
Name: Phone: - -

Writing Sample
Please use the space below to tell us why we should consider hiring you.

EEO Self-Identification Form

Venture Data L.L.C is an equal employment opportunity employer.

The information below is needed to measure the effectiveness of our recruitment efforts and is in conformity with federal government guidelines, which require us to compile statistical information about applicants for employment. You are not required to furnish this information, but are encourage to do so. The law provides that an employer may neither discriminate on the basis of this information nor on whether you choose to furnish it.

Sex Identification? Male Female
Minority Status Identification Caucasian/White (Not Hispanic or Latino) African American/Black Hispanic or Latino Asian (Not Hispanic or Latino) American Indian or Alaskan Native (Not Hispanic or Latino) Native Hawaiian or Other Pacific Islander Two or more races (Not Hispanic or Latino)

Please Check If The Following Categories Are Applicable

Disabled Individual - Any person who (1) has a physical or mental impairment that substantially limits one or more of his/her major life activities: (2) has a record of such impairment, or (3) is ergarded as having such impairment. A disability is "substantially limiting" if it is likely to cause a difficilty in securing, retaining, or advancing in employment.

Vietnam Era Veteran Eligibility - Served in armed forces between August 5, 1964 and May 7, 1975, for more than 180 days of active duty.

Disabled Veteran Eligibility - A veteran with a disablity, service connected or otherwise.

Applicant Statement

The information I am presenting in this application is true and correct to the best of my knowledge and I understand that any falsification or misrepresentation herein could result in immediate termination of employment. I understand and agree that if hired, my employment will be "at will". That is that either I or Venture Data may end the employment relationship at any time,for any reason, or without cause. In the event of employment, I agree to abide by all company rules, policies, and procedures of Venture Data.

Please click here to certify you have read and agree to the above statement

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