Application For Employment


Thank you for your interest in BRG Research Services. This application is used to apply to work in our call center in Provo, Utah.   If you would like to work for BRG Research Services but live too far from the call center, please use the back button on your browser and instead fill out the application to work from home.  Be sure to read all the information about the work from home position before applying.  Thank you!

 

 

    
 

Full Name:

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Address:

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City:

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State:

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Zip:

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Phone:

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Email:

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Have you ever worked for BRG Research Services?* Yes No
 

If yes, Please provide information as to why stopped working
 

 

 
 

How did you hear about BRG?

 

If referred, by whom?              

 

 
 

Type of Employment Desired::* Full Time Part Time

 

Select Days and Times available:
 

 

 Mon Tues
Wed
Thurs
Fri
Sat
Sun
 
 
 

 

    
 
 
 
 
 
 

 

    
 

Are you a citizen of the United States or do you have a right to be legally employed in the US?*
Yes No  
 

If not a citizen of the United States, can you provide proof that you can legally be employed in the US?*
Yes No  
 

Have you ever been convicted of a felony?*
Yes No   If yes, please explain:

 

 

    
 

 

    
 
 
 

 

 Institution Name Location
Diploma/Degree
Major
 

High Sch:
 

College:
 

Graduate:
 

Other:
 

 

    
 
 
 

 

    
 

Have you ever had experience in research?
Yes No
 

Have you ever had experience in data entry or coding?
Yes No
 

Typing Speed 10-Key Speed

 

List any other skills you think will help us in determining your qualifications

 

Other than English, are there any other languages you can speak fluently?
Yes No   If yes, please list:
 

Explain why BRG Research Services should hire you to be a Call Center Agent: (Be as specific as possible, including all skills, language skills, past experience and current certifications you may hold)
 

 

    
 

 

    
 

Most Recent or Current Employer

 Address & Phone  
 

 
 

Date Started:

Name of Supervisor / Title  
 

Date Ended:  

 
 

Starting Wages:

 Reason For Leaving:  
 

Ending Wages:

 
 

Explanation of Your Position

    
 

 
 

 

    
 

 

    
 

Previous Employer

 Address & Phone  
 

 
 

Date Started:

Name of Supervisor / Title  
 

Date Ended:  

 
 

Starting Wages:

 Reason For Leaving:  
 

Ending Wages:

 
 

Explanation of Your Position

    
 

 
 

 

    
 

 

    
 
 

Provide two references, preferably former, or current employer(s).
If not an employer please provide two references that are of no relation to you:
 

Name:

 Name:
 

Employer:

 Employer:
 

Relationship:

 Relationship:
 

 

    
 
 

 

    
 

I certify that all information provided by me herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application does not constitute and is not intended to be a contract of employment. IN the event of employment, I understand that false or misleading information, or omission of, given in my application or interview(s) may result in discharge. I understand, that I will be required to abide by all the rules, regulations, policies and procedures of BRG Research Services.

 

 

 

Initials:*


BRG Research Services, Inc. is an Equal Opportunity Employer. Applicants are considered for all positions without regard to political affiliation, religion, gender, race, color, national origin, sexual orientation, ability, marital or veteran status, the presence of an on-job-related medical condition or handicap, or other status protected under local, state or federal laws.