Vermillion, Inc, Employment Portal

316.641.8981

Vermillion Incorporated is an Equal Opportunity Employer and does not discriminate against otherwise qualified applicants on the basis of race, color, religion, sex, national origin, age, marital status, disability, handicap, veteran status, or any other basis prohibited by applicable law.

NOTE: This application is split into one section per page until you reach the final submit button. Starting with this page, please double check your information for accuracy before advancing to the next page. Once all sections/pages are filled out, you will see a submission button to submit your application. Your application isn’t submitted until you click that final button.

PERSONAL INFORMATION

First Name*

Middle Name* I do not have a middle name.

Last Name*

Street Address*

City*

State*

Zip*

Daytime Phone*

Evening Phone

Email Address*

Are you 18 years of age or older?* Yes No

Are you a US Citizen?* Yes No

Are you legally authorized to work in the United States?* Yes No

Will you now or in the future, require sponsorship for employment visa status (e.g. H-1B visa status)?* Yes No

Have you been convicted of a crime other than minor traffic offense?* Yes No

Please provide date of conviction and explanation.*

A conviction will not automatically disqualify you from employment.

Are you currently bound by a noncompetition agreement? Yes No

Please provide details.*

Have you previously been employed by Vermillion Incorporated?* Yes No

Are you related to current employees of Vermillion Incorporated?* Yes No

Please provide name and their relation to you. *

HOW DID YOU HEAR ABOUT VERMILLION INCORPORATED?

Please enter referral information.*

EDUCATIONAL HISTORY

Do you have a High School Diploma or GED? * Yes No

HIGH SCHOOL/GED EDUCATION + COLLEGE/UNIVERSITY, TECHNICAL OR TRADE SCHOOL EDUCATION

NOTE: List high school / GED first, then add as many sections as you need to complete your history.

Name of Institution

City/State

Major/Program

Completed *

Year of Completion*

X Delete Section

+ Add Section

Please list any relevant certifications or skills:

Certifications/Skills

Please list any computer skills/experience:

AVAILABILITY / SALARY

Position Applied For: Program Management Assistant

Shift Preference: *

1st Shift

2nd Shift

What date can you start working? *

Hourly Wage Preference* $ to $ per hour

UPLOAD RESUME

I do not have a resume.

Upload File*

Allowed File Types: pdf, docx, rtf, txt, jpeg, png

NOTE: You must check first box that says ‘No Prior Work Experience’. OR add last 3 employers, OR add last 5 years of work history.

EMPLOYMENT HISTORY

No Prior Work Experience

LIST CURRENT OR MOST RECENT EMPLOYMENT FIRST (INCLUDE ANY MILITARY SERVICE)

NOTE: Add as many sections as you need to complete your history.

Company Name*

Company Address

City *

State

Zip

Supervisor’s Name/Job Title*

Supervisor’s Phone Number

Current Employer

Start Date*

End Date*

Duties/Responsibilities*

Reason for Leaving*

May We Contact This Employer?*

X Delete Section

+ Add Section

What is your current or most recent pay?*

PROFESSIONAL REFERENCES

Name*

Relationship*

Email*

Phone*

Name

Relationship

Phone

PERSONAL REFERENCES

Name*

Relationship*

Email*

Phone*

Name

Relationship

Phone

EQUAL OPPORTUNITY/AFFIRMATIVE ACTION

What is your gender?* Male Female

Please choose one that describes your ethnicity*

Hispanic or Latino

White (Not Hispanic or Latino)

Black or African American (Not Hispanic or Latino)

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)

Asian (Not Hispanic or Latino)

American Indian or Alaskan Native (Not Hispanic or Latino)

Two or More Races (Not Hispanic or Latino)

I prefer NOT to disclose my ethnicity.

Please check one if it describes your U.S. military, ground, naval or air service veteran status*

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 Secretary of Veterans Affairs, or a person who was discharged or released from active duty because of a service‐connected disability.

Other Protected Veteran: A veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized.

Armed Forces Service Medal Veteran: A veteran who, while serving on active duty participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Recently Separated Veteran: A veteran who was discharged or released three or less years from this date.

Covered Veteran: A veteran as defined in the four categories above.

None: I am NOT a protected Veteran.

Unknown: I AM a Veteran but I prefer NOT to disclose my Veteran status.

APPLICANT'S CERTIFICATION AND AGREEMENT

Applicant’s Certification and Agreement

To the best of my knowledge, all information on this application is true and correct. I authorize Vermillion, Inc. to use the information given to determine my eligibility for employment, including contacting each of my former employers listed concerning my qualifications for employment. Permission is granted to each of my former employers to give Vermillion, Inc. information regarding my work experience. I understand that fraudulent statements made in this application may be cause for disqualification for employment at or dismissal from Vermillion, Inc.

Further, I understand that any offer of employment is contingent upon satisfactory results of a drug test; therefore I agree to submit to a drug test at any time deemed appropriate by Vermillion, Inc. and as permitted by law. I understand that some positions within Vermillion, Inc. may also require satisfactory results of a medical and/or vision examination and I agree to submit to such examination at any time deemed appropriate by Vermillion, Inc. and as permitted by law. I consent to allow the test providers to disclose the results from any required drug test or medical or vision examination to Vermillion, Inc.

I hereby understand and acknowledge that all employees who do not have a written, individual employment contract with a specific, fixed term of employment approved by the President are employed for an indefinite duration “at will” by Vermillion, Inc. Absent of the aforementioned agreement and in accordance with Kansas law, I or Vermillion, Inc. may terminate my employment at any time with or without notice or cause. If I am hired, I understand that a condition of my employment will be to abide by the company’s policies, rules, and regulations.

This application will remain active and in consideration for one year. Consideration for employment after one year from submission requires a new application. Thank you for your interest in Vermillion!

Applicant’s Signature *

12/04/2024