APPLICATION FOR EMPLOYMENT

please complete all information requested except for signature

PLEASE FILL OUT ALL FIELDS. DATE: 
Referral Source:  Are you legally eligible for employment in this country?    
Name      
  Last First Middle Maiden
Present address
  Number Street City State ZIP
How long?  Telephone  Social Security No.(XXX-XX-XXXX) 
Email address: 
Position applied for     (1)

and salary desired       (2)
(Be specific)
Days/hours available to work
No Pref  Thur 
Mon  Fri 
Tue  Sat 
Wed  Sun 
If necessary, best time to call you at home is
    		If okay to call you at work, phone number and best time to
call     
If under 18, can you furnish a work permit?    Are you on lay-off or subject to re-call?  
Will you relocate if job requires it?   Will you travel if job requires it?  
Will you work overtime if required?  
How many hours can you work weekly?                                              Can you work nights?  
Employment desired                
Date available for work:  

 

List last 4 schools of each type. Please enter information in comma seperated list.

TYPE OF SCHOOL NAME OF SCHOOL
(Last)		 LOCATION
(Complete mailing address)		 NUMBER OF
YEARS
COMPLETED		 GPA
CLASS
RANK		 MAJOR
&
DEGREE
High School
College
Bus. or Trade School
Professional School

 

HAVE YOU EVER BEEN BONDED?    
HAVE YOU EVER BEEN CONVICTED OF A FELONY?           
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were commited, sentence(s) imposed, and type(s) of rehabilitation.
  

 

DO YOU HAVE A DRIVER'S LICENSE?        
What is your means of transportation to work?  
Driver's license
number       State of Issue          
Expiration date 
Have you had any accidents during the past three years?                                                                   How Many? 
Have you had any moving violations during the past three years?                                                         How Many? 

 

Please list two references other than relatives or previous employers.
Name  Name 
Position  Position 
Company  Company 
Address  Address 
Telephone  Telephone 
An application form somethimes makes it difficult for an individual to adquately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

 

  Military  
HAVE YOU EVER BEEN IN THE ARMED FORCES?
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?
Specialty    Date Entered    Discharge Date 

 

Work Experience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

 

Name of employer
Address
City, State, ZIP Code

Phone number
Name of last
supervisor		 Employment dates Pay or Salary
  From
To 		Start
Final
May we contact for reference?     Your last job title: 
Reason for leaving (be specific) 
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
 

 

Name of employer
Address
City, State, ZIP Code

Phone number
Name of last
supervisor		 Employment dates Pay or Salary
  From
To 		Start
Final
May we contact for reference?     Your last job title: 
Reason for leaving (be specific) 
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
 

 

Name of employer
Address
City, State, ZIP Code

Phone number
Name of last
supervisor		 Employment dates Pay or Salary
  From
To 		Start
Final
May we contact for reference?     Your last job title: 
Reason for leaving (be specific) 
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
 

 

Name of employer
Address
City, State, ZIP Code

Phone number
Name of last
supervisor		 Employment dates Pay or Salary
  From
To 		Start
Final
May we contact for reference?     Your last job title: 
Reason for leaving (be specific) 
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
 

 

May we contact your present employer?        

Did you complete this application yourself?    

If not, who did? 

 

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER
In exchange for the consideration of my job application by ProComm Telecommunications, Inc. (hereinafter called “the company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the content of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right remain an employee of ProComm Telecommunications, Inc., or otherwise to change in any respect the employment-at will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/ General Manager of the Company. Both the undersigned and ProComm Telecommunications, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employment (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Signature of applicant:  To be signed at initial interview.                                                                  Date: 

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, or disability. We assure you that your opportunity for employment with this company depends solely on your qualifications.
Thank you for completing this application form and for your interest in our business