Employment Application
We consider applicants for all positions without regard to race, color, religion, creed, gender,nationalorigin, age, marital or veteran status,sexual orientation, or any other legally protected status. All employment is subjected to the company’s employee handbook. First Name Last Name Middle Name Street City State Zip Telephone No.: Cell: SSN: POsition Applied for How did you hear about usAdvertisement Employment Agency Friend Relative Other Application Date
Note: If you are applying for a technician position you must have the proper working tools. Please see tool list attached. Also you must have a valid driving license with and clean record and at least four years of driving experience. Yes No If you are under 18 years of age, can you provide require proof of your eligibility to work? Yes No Have you ever filed an application with us before? If yes, give date
Yes No Have you ever been employed with us before? If yes, give date
Yes No Are you currently employed? Yes No May we contact your present employer? Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be require upon employment) On what date would you be available for work?
Are you available to work Yes No Are you currently on “lay-off” status and subject to recall?Yes No Can you travel if a job requires it? Amount of salary requested? Yes No Have you ever been arrested before? Yes No Have you ever been convicted of a felony? (conviction will not necessarily disqualify applicant from employment). If yes, please explain Select the qualifying documents which you have:List A Documents that Establish Both Identity and Employment Eligibility Expired Unexpired U.S.Passport (unexpired or expired) Certificate of U.S. Citizenship (INS Form N-560 or N-561) Certificate of Naturalization (INS Form N-550 or N-570) Unexpired foreign passport, with I-551 stamp or attached INS Form I-94 indicating unexpired employment authorization. Alien Registration Receipt Card with photograph (INS Form I-151 or I-551) Unexpired Temporary Resident Card (INS Form I-688) Unexpired Employment Authorization Card (INS Form I-688A) Unexpired Reentry Permit (INS Form I-327) Unexpired Refugee Travel Document (INS Form I-571) Unexpired Employment Authorization Document issued by the INS which contains a photograph (INS Form I-688B) OR List B Documents that Establish Identity Driver’s license or ID card issued by a state or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, sex, height, eye color, and address. ID card issued by federal, state or local government agencies or entities provided it contains a photograph or information such as name, date of birth, sex, height, eye color, and address. School ID card with a photograph Voter’s registration card U.S. military card or draft record Military dependent’s ID card U.S. Coast Guard Merchant Mariner Card Native American tribal document Driver’s license issued by a Canadian government authority For persons under age 18 who are unable to present a document listed above: School record or report card Clinic, doctor, or hospital record Day-care or nursery school record ANDList C Documents that Establish Employment Eligibility U.S. social security card issued by the Social Security Administration (other than a card stating it is not valid for employment). Certification of Birth Abroad issued by the Department of State (Form FS- 545 or Form DS-1350) Original or certified copy of a birth certificate issued by a state, county, municipal authority or outlying possession of the United States bearing an official seal Native American tribal document U.S. Citizen ID Card (INS Form I-197) ID Card for use of Resident Citizen in the United States (INS Form I-179) Unexpired employment authorization document issued by the INS (other than those listed under List A)Education Name and Address Of School Course of study Years Completed1 2 3 4 5 Diploma/DegreeElementary Junior High High School College Masters PhD Indicate foreign languages you speak Describe any specialized training, apprenticeship, skills, and extra-curricular activities Describe any job-related training received in the United States militaryEmployment Experience Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations, which indicate race, color, religion, gender, national origin, or protected status. Employer Telephone Number Address Supervisor's name Dates Employed
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Work Performed Hourly Rate/Salary Starting Final Job Title Reason for Leaving
References: 1.(NAME) (PHONE#) (ADRESS) 2.(NAME) (PHONE#) (ADRESS) 3.(NAME) (PHONE#) (ADRESS)Please check all that you have experience with. If something isn’t listed that you have experience with please write it in the space provided that says other. Core Competencies: Cat 5/5E/6: Fiber: Network Design: Telecom: Internet Service: Network Install: H/R/ Repair/Maint: Wireless: Satellite: Other:System Integration: Telecom- (T) and/or Datacomm- (D) Analysis: Design: Installation: Training: Maintenance: Configuration: Other:Type of work capable of performing: Aerial Work: Conduit/Manhole: Excavating: Plowing: Trenching: Underground cabling: Fiber Optic: Drop Placement: Boring/Pipe pushing: Cable Maint: Tree & Brush trimming: Pre-wire/SNI: Telephone Plant design: Locating buried cable: Dmarc extensions: Wireless Tower installation: Satellite installation: Other:Test Equipment: T-Berd Comm Analyzer , Opt net , Sunset , Inet ,Ameritech , Wirescope , Fluke , Techtronix Other:Applicant’s Statement I certify that answers given here in 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, including but not limited to credit, background, criminal, and driving records. This applicant for shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this period should inquire as to whether or not applications are being processed a this time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the employee may rezign at any time and the employer may discharge employee at any time with or without cause. It is futher understood that this "at will" employment relationship may not be changed by any written document or by conduct unless an authorized executive of this organization specifically acknowledges such change in writting. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of the employer. Signature of Applicant: Date::