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Title: Electronic Technician

Fields marked with an asterisk (*) must be filled out before submitting.

Contact Information

Last Name: *
First Name: *
Address: *
Address (line 2):
City: *
State: *
Zip: *
Phone: *
Email: *

Attachments

Resume:
Do you have a degree? * Yes
No
Cover Letter:

Personal Information

Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment): * Yes
No
Are you at least 18 years or older? (If no, you may be required to provide authorization to work): * Yes
No
Have you ever worked or attended school under another name? * Yes
No
If yes, what name(s)?
Have you ever been convicted of a felony or a misdemeanor which resulted in imprisonment within the last seven years? (A conviction will not necessarily result in denial of employment): * Yes
No
If yes, please explain:
Have you ever worked for this company before? * Yes
No
If yes, provide details (where, when, job title):
Are you able to peform the essential functions of the job for which you are applying, with or without a reasonable accommodation? * Yes
No
If no, please explain:

Employment Desired

When would you be available to begin work? *
Type of employment desired: * Full-Time
Part-Time
Seasonal
Hourly rate/salary desired: *
Are you currently employed? * Yes
No
If so, may we inquire of your present employer? Yes
No
If presently employed, why are you considering leaving?

Education

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School name and location:
Did you graduate? Yes
No
Degree(s) received:
 
School name and location:
Did you graduate? Yes
No
Degree(s) received:
 
School name and location:
Did you graduate? Yes
No
Degree(s) received:
If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

Employment History

Employer 1

Employed From:
Employed To:
Employer Name:
Employer Address:
Employer Phone:
Job Title:
Supervisor Name and Title:
May We Contact? Yes
No
Responsibilities:
Reason For Leaving:
Starting Salary/Hourly Rate:
Ending Salary/Hourly Rate:

Employer 2

Employed From:
Employed To:
Employer Name:
Employer Address:
Employer Phone:
Job Title:
Supervisor Name and Title:
May We Contact? Yes
No
Responsibilities:
Reason For Leaving:
Starting Salary/Hourly Rate:
Ending Salary/Hourly Rate:

Employer 3

Employed From:
Employed To:
Employer Name:
Employer Address:
Employer Phone:
Job Title:
Supervisor Name and Title:
May We Contact? Yes
No
Responsibilities:
Reason For Leaving:
Starting Salary/Hourly Rate:
Ending Salary/Hourly Rate:

Authorization

The facts set forth in this application and any supplemental information is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of the company has the authority to make any assurance to the contrary.

I understand that I am required to abide by all rules and regulations of the company.

Signature (type name): *
Date: *

Equal Opportunity Employment

The following questions are VOLUNTARY and help us to track our hiring processes in compliance with equal employment policies. Information you enter here will NOT be seen by the hiring manager.

Your Gender: Female
Male
Your Race: American Indian or Alaska Native (Not Hispanic or Latino)
Black or African-American (Not Hispanic or Latino)
Hispanic or Latino
Asian (Not Hispanic or Latino)
White (Not Hispanic or Latino)
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
Two or More Races (Not Hispanic or Latino)
Veteran Status: Vietnam Era Veteran
Disabled Veteran

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