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Support Systems, Inc.

1120 Bypass Road-Vinton, VA-24179

Employment Application

Support Systems, Inc. is an equal opportunity employer and does not discriminate on the basis of race, religion, color, national origin, age, sex, gender, disability or any other characteristic protected by law.

Applicant Information



Please list three professional references.

Previous Employment

Specialized Skills & Knowledge

Please list any skills or knowledge that shows your ability to perform the job for which you are applying, (examples are computer experience, volunteer experience, software knowledge, etc.)

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Information Release

I,, understand it will be necessary for Support Systems, INC to conduct a background check regarding my driving record, criminal history, personal references, and employment.

I authorize Support Systems, INC to obtain any needed information regarding my driving record, legal/criminal history, character references, and employment from any state or federal agency, my employer, and personal references for purposes of participating in a mentoring program.

Further, I provide permission for Support Systems, INC to conduct the same investigation of my background in previous states in which I have resided.

Please list any other cities, states, and dates of residency during the past 10 years.
City State From (Month/Year) To (Month/Year)