First Name *
Middle Name *
Last Name *
Present Street Address *
Present City *
Present State * Choose a stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Present Zip Code *
Permanent Street Address *
Permanent City *
Permanent State * Choose a stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Permanent Zip Code *
Phone Number ( no hyphens ) *
Check the box if you are 18 years or older? *
Check the box if you are prevented from lawfully becoming employed in this country because of visa or immigration status?
Date you can start
Are you employed now? -----YesNo
If so may we inquire of your present employer?
Ever applied to Catalyst before? -----YesNo
If so when?
Name and Location
Number of Years Attended
Did you graduate Grammar School? ------YesNo
Did you graduate High School? ------YesNo
Did you graduate College? ------YesNo
Trade Business or Correspondence School
Did you graduate from the school? -----YesNo
GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.
Number of Years Acquainted
Catalyst Card Company conducts a full civil, criminal and financial background check on each prospective employee. This includes fingerprinting and drug testing.
An arrest or a conviction will not necessarily bar an applicant from employment.
Please provide all prior residential addresses for the past 7 years and any alias or other names used
City / State / Zip
Alias or Other Name Used
Subjects of Special Study or Research Work
U.S. Military or Naval Service
Check the box if you are a present member in the National Guard or Reserves
We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.
This company is an at-will employer as allowed by applicable state laws. This means that regardless of any provision in this application, if hired, the company or employee may terminate the employment relationship at any time, for any reason, with or without cause or notice. Nothing in this application or in any document or statement, written or oral, shall limit the right to terminate employment at will. No officer, employee or representative of the company is authorized to enter into an agreement – expressed or implied – with you or any applicant for employment for a specified period of time unless such an agreement is in a written contract signed by the president of the company. If hired, you agree to conform to the rules and regulations of the company.
Please provide all former employment information that would cover the past 7 years. Provide information to explain any gaps between jobs, exceeding 3 months.
Reason for leaving
Employed from date
Employed to date
Explanation for gaps if any
Reaon for leaving
Driver Motor Vehicle Report
I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside.
I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company’s policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state, and local law.
Investigations on company property
If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.
I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement.
I certify that all the information on this application, my résumé, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.
Initial and Annual Background Check
I authorize the Company or its agents to confirm all statements contained in this application and/or résumé as it relates to the position I am seeking to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation which may be permitted by federal, state and/or local law. If applicable and allowed by law, I will receive separate written notification regarding the Company’s intent to obtain “consumer reports.”
This authorization, whether in original or copy form shall be valid for the entire term of my employment, should I be hired by Catalyst Card Company. I understand that an annual background check will be conducted by Catalyst Card Company, as long as I am employed.
I understand that my employment is contingent on receipt of satisfactory background, fingerprints & drug test results
Please type your name here to verify that the above information is correct *
Date submitted *
2 + 1 = ? Please prove that you are human by solving the equation *