Freelance Application for Healthcare Inspirations

Personal Data

If you prefer to not send us this information over the internet. You may print out this application form and fax it to (877) 250-2559. Or mail to: Allen Perri Design Group, Ltd. 4225 Mason Avenue - Sacramento CA 95821

First Name:

Last Name:

Position you are applying for:

Email Address

Present address (street, city, state, zip):

Cell Phone:

Freelance hourly rate:

Date you are available:

Do you prefer to work:

Onsite (in our offices)

Offsite (using your own equipment)

Either (doesn't matter)

Have you attained the age of 18?

Yes

No

Have you ever been convicted of a felony?
(Answering yes will not disclude your eligibility for this position):

Yes

No

Do you have the legal right to work in the U.S.?

Yes

No

Special Skills

Please indicate if you have specific experience with the following equipment:

Please list other types of office and production equipment you can operate:

Please list any special skills you have related to production, design, illustration or copywriting:

Please indicate which computer/operating systems you can operate along with your ability level and the number of years experience:

Please indicate which computer programs you can operate along with your ability level
Please note that not ALL of the programs listed below may be required for the job you are applying for:

How many words per minute can you type?:

Do you have a valid driver's license?:

Yes

No

Do you have access to a car?

Yes

No

Portfolio

If you have web design experience, please list below urls of website you have worked on. Please describe in detail in what capacity you worked on the project. Please make sure to include http://www. in front of each url. Thanks.

Please upload your resume detailing your employment history (PDF and MS Word documents are acceptable)

If you would like to upload a PDF file showing samples of your work, please do so here. Please DO NOT send a file that is more than 1MB.

CERTIFICATION
By clicking the SUBMIT button below, I hereby certify that all entries on this application and attachments are true and complete, and I agree and understand that any falsification of information herein, regardless of time of discovery, may cause forfeiture on my part of any employment for the Allen Perri Design Group. I understand that all information on this application is subject to verification and I consent to criminal history background checks. I also consent that you may contact references, former employers and educational institutions listed regarding this application. I further authorize the Allen Perri Design Group to rely upon and use, as it sees fit, any information received from such contacts.

	No Exp	Beg	Interm	Advanced	Years of Exp
Color Laser Printer
Large-format Ink-Jet Printer (44")
Large-format sheet-fed laminator
Large-format roll-fed laminator

	No Exp	Beg	Interm	Advanced	Years of Exp
Mac OS 10.5+
X Serve
Windows Vista

	No Exp	Beg	Interm	Advanced	Software Vers #
Quark
Abobe Illustrator
Adobe PhotoShop
Macromedia Flash
Adobe Acrobat
DreamWeaver
Microsoft Word
Microsoft Excel
Microsoft PowerPoint