Elayne Scott

Intro text here.

Name

Address

City

State

Zip

Phone (home)

Phone (work)

Phone (cell)

Phone (emergency)

Salary Requirement

	Annual	Monthly	Hourly

Type of Employment

	Temporary	Permanent	Temp to Perm

Please check the areas you are willing to work

	Center City	Northeast
	Media	Bala Cynwyd
	Norristown	Conshohocken
	Plymouth Meeting	Blue Bell
	Paoli	Malvern
	Radnor	King of Prussia
	West Chester	Lansdale
	Doylestown	Jenkintown
	Bensalem	Trenton
	Cherry Hill	Newark, DE

Please check the positions you are interested in

	Attorney
	Paralegal
	Legal Secretary
	Word Processor
	Receptionist
	Administrative Assistant
	File Clerk

When are you available to interview?

When can you start work?

Are you currently employed?

What was your last salary?

Why did you leave your last position?

Legal Experience (number of years experience)

	Medical Malpractice	Personal Injury (Plaintiff)
	Personal Injury (Defense)	Insurance Defense
	Civil Litigation	Product Liability
	Intellectual Property	Family Law
	Immigration Law	Labor & Employment
	Estates & Trusts	Tax
	Real Estate	Transactional
	Corporate	Securities
	Bankruptcy	Business Litigation
	Construction Defect	Worker's Compensation

Software Experience (number of years experience)

	WordPerfect	GroupWise
	Microsoft Word	iManage
	Excel	Other
	PowerPoint

When will you work?

	Days
	Evenings
	Weekends
	Overtime

How did you hear of us?

	Referral from
	Other

Where have you interviewed (so we don't send your resume there)

Are you bilingual?

If yes, what Language?

Do you have a car?

Do you know shorthand?

Have you used Dictaphone?

Typing Speed

Education (High School)

	School Name
	Number Years
	Degrees/Certificates

Education (College)

	College Name
	Number Years
	Degrees/Certificates

Education (Paralegal Program)

	Program Name
	Number Years
	Degrees/Certificates

Education (Graduate School)

	School Name
	Number Years
	Degrees/Certificates

Work Experience (Most Recent)

	From (date)
	To (date)
	Total Time
	Company
	Address
	Type of Law
	Duties
	Position
	Salary
	Reason for leaving
	Supervisor Name
	Supervisor Title
	Supervisor Phone

Work Experience

	From (date)
	To (date)
	Total Time
	Company
	Address
	Type of Law
	Duties
	Position
	Salary
	Reason for leaving
	Supervisor Name
	Supervisor Title
	Supervisor Phone

Work Experience (Least Recent)

	From (date)
	To (date)
	Total Time
	Company
	Address
	Type of Law
	Duties
	Position
	Salary
	Reason for leaving
	Supervisor Name
	Supervisor Title
	Supervisor Phone

Have you ever been convicted of a felony?

Upload Resume--WordPerfect or MS Word only. (click folder icon)

Placement Agreement

ELAYNE SCOTT ASSOCIATES (ESA) will (or has) without fee due from me, undertaken to attempt to introduce to me, employ me for, place me with, or assign me to, various employers for the purpose of servicing their temporary and permanent positions. ESA will (or has) charge(d) a fee exclusively to the employer. In consideration of this, I agree to all of the following terms and conditions:

For 30 months from the later of the date this application is submitted, or the date of my last ESA introduction, employment, placement, assignment or service, I promise to refrain from soliciting or accepting, introduction to, temporary or permanent employment by or for, or placement with, or assignment or service to, ("direct or indirect placement") any employer (or their successors(s)) to whom I have been, or will be, introduced, employed by or for, placed with, or assigned to, by ESA, whether the direct or indirect placement results from my own efforts or through those of any employment agency, contractor, or other enterprise or person, including the employer (or successor(s)). ESA may consent, in writing, to waive the forgoing if I make written request for the same via certified mail, return receipt requested, 7 days prior to direct or indirect placement to a former ESA employer (or their successor(s)).

Should I fail to comply with the above, I promise to pay ESA either the net fees that ESA would have been able to bill such employer (or successor(s)) for my employment, placement, assignment or service, had the same been through ESA, or $25 per each day of the same, not as a penalty but as liquidated damages, at the exclusive option of ESA. Should I fail to pay as so invoiced, within 15 days of the invoice date, I agree to pay interest of 12% per year on the same, together with a reasonable attorney fee if so placed for recovery. I have read and understood all of the foregoing, intend to be legally bound, and acknowledge reading this placement agreement. In addition, I hereby certify that the information contained in this application form is true and correct to the best of my knowledge.

I have read, and accept the Placement Agreement above

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