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First name
Last Name
Phone (Home)
Phone (Cell)
Home Address
click here to input address
Job Interests
How did you become aware of PCS ?
Applied to a Job Posting (Monster, Career Bulider, etc)
Referred By Current or Former PCS EMployee
I was contracted by a PCS Recruiter
PCS found my resume online and called me
College or University Career Center
Other Explain
My Resume is posted on which of the following Sites ?
Career Builder
College Carrer Website
Other, Explain
Have you ever worked for PCS in the past
Yes No
Are you legally authorized to work in the United States
Yes No
Do You have reliable transportation to get to/from work?
Yes No
Any Offer of emplyment, if made, may be contingent on passing a background check. Massachusetts & Hawaii Applicants Only: Under Massachusetts & Hawaii law, an employer is prohibited from making written, pre-employment inquiries of an applicant about his or her criminal history. MASSACHUSETTS & HAWAII APPLICANTS SHOULD NOT RESPOND TO THESE QUESTIONS SEEKING CRIMINAL INFORMATION
Have you ever been convicted of a felony
Yes No I am a Massachusetts & Hawaii Applicant
(Arrests are not convictions; do not include convictions that have been sealed, expunged or set aside)
Have you ever been convicted of a misdemeanor involving theft or violence within the past 7 years
Yes No I am a Massachusetts & Hawaii Applicant
(Arrests are not convictions; do not include convictions that have been sealed, expunged or set aside)
By checking this box, I certify that to the best of my knowledge and belief, all of the information and statements contained above are true, correct and complete, I am aware that any ommisions, falsifications, or misrepresentations above may disqualify me for emplyment consideration and, if hired, may be grounds for termination at a later date. If hired, I understand that I will be an at will employee and that my employment may be terminated by PCS or me at any time with or without cause
  I accept

Employer Data Record- Voluntary Survey

Employees are considered during the application process, and are treated during employment, without regard to race, color, religion, sex, national origin, age, marital or veteran status, disability, or any other legally protected status.
The purpose of this Data Record is to comply with government record keeping, reporting, and other legal requirements. As an equal opportunity employer, we comply with government Affirmative Action regulations where they apply. As part of our record keeping requirements, we request that you provide the information below. Periodic reports may be made to the government on the following information. The completion of this Data Record is entirely optional. This Data Record will be placed in a separate file before your Application is considered and is not a part of your Application for Employment or your personnel file. YOUR PARTICIPATION IN THIS SURVEY IS VOLUNTARY AND WHETHER YOU PROVIDE OR DO NOT PROVIDE DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION.
Gender Male
Do not wish to disclose
Ethnic Origin White (Non-Hispanic and Non-Latino)
a person having origins in any of the original peoples of Europe, the Middle East or North Africa

American Indian/Alaskan Native
a person having origins in any of the original peoples of North and South America (including Central America) and who maintain tribal affiliation or community attachment

Native Hawaiian or Pacific Islander
a person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands

Hispanic or Latino
a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race

Black or African American
a person having origins in any of the black racial groups of Africa

a person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam

Two or More Races
all persons who identify with more than one of the above five races

Do not wish to disclose
Veteran Status Please check all of the descriptions below that apply.
I am a disabled veteran
A veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans Affairs for a disability; or a person who was discharged or released from active duty because of a service-connected disability.

I am a recently separated veteran.
Any veteran during the three-year period beginning on the date of discharge or release from active duty.

I am a campaign Veteran.
A veteran who served on active duty in the U.S. military, ground, naval, or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.

I am a Armed Forces Service Medal Veteran
A veteran who, while on serving on active duty in the U.S. military, ground, naval, or air service, participated in a United States military operation for which an Armed Forces Service Medal was awarded, while serving on active duty in the Armed Forces, pursuant to Executive Order No. 12985 (61 Fed. Reg. 1209).

None of the above apply

Do not wish to disclose.
Voluntary Self-Identification of Disability
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.1 To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Cerebral palsy
Muscular dystrophy
Bipolar disorder
Major depression
Multiple sclerosis (MS)
Missing limb or partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)
Please check one of the boxes below
YES, I HAVE A DISABILITY (or previously had a disability)
Reasonable Accomodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
1. Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at
PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.