Employment Application

We appreciate your interest in coming to work with United Systems of Arkansas. Please complete this application to help us better evaluate your qualifications and experience. Each section has its own directions. If you would like us to review your resume, please send it via email to support@unitedsystems.net. If you have any questions about any portion of the application, feel free to contact us at support@unitedsystems.net.

Personal Information:

If you have lived at the above address for less than a year, what was your previous address?

Do you have any handicap or health condition that might affect your ability to perform the duties of the position you have applied for?

If “yes”, please give details:

Have you ever been convicted of a felony?

If “yes”, please give details:

If hired, can you provide documents to prove your eligibility to work legally in the United States?

If hired, will you sign a confidentiality/nondisclosure/non-compete/work-done-for-hire agreement?

Education and Training:

Please complete this information for all formal education and any training or other programs that you feel might be related to the position you are applying for. If you provide a resume containing this information, fill in only the blanks that request information not included in your resume.

Work Experience:

Please complete this information for your previous employment, beginning with your current or most recent position. You need not go further back than eight years, unless you wish. Do not leave any gaps in time. If you were unemployed or attending school during a time period, please note that time. If you provided a resume with this information, complete only the blanks that request information not included on your resume.

Employer 1

Time between employment?

Employer 2

Time between employment?

Employer 3

Time between employment?

Employer 4

Time between employment?

Employer 5

Volunteer and Other Experience:

Describe briefly volunteer work or other unpaid experience which may relate to the position you are applying for. If this information is included on a resume you have provided, you need not complete this section.


Please provide the names of three people we may contact for personal references. If you provided this information with a resume, you need not complete this portion of the application.

Reference 1

Reference 2

Reference 3

Other Information:

If there is any other information you feel would be helpful to us in evaluating your experience and qualifications for this position, please write in the space below.

Certification and Release

By clicking the "Submit Application" button below, I represent that the information I have provided in this application is true and correct to the best of my knowledge and belief. I understand that, if I am hired, my having made any misstatement of fact in this application may result in termination.

I also give permission for the release of information from all former employers and other persons named in this application to United Systems of Arkansas for its purposes in evaluating my qualifications and suitability for the position I have applied for. If I am hired my permission is granted for a background check.

United Systems of Arkansas (USA) is an Equal Employment Opportunity employer. It is the policy of USA to select the best qualified person for each position. No employee of USA will discriminate against an applicant for employment or a fellow employee because of race, creed, color, religion, sex, national or ethnic origin, physical or mental handicap or because of the person’s veteran status. This policy applies to all employment practices and personnel actions.