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Employment Application
1
General Information and Education
2
References and Experience
3
Confirmation
4
Authorization of Release
General Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Home Phone
*
Cell Phone
*
Email
*
Date available for employment
*
MM slash DD slash YYYY
Are you available for:
*
Full time
Part time
Over time
(please select all that apply)
Hours / Days Available
*
Position you are seeking
*
Wage Desired
*
Do you have a VALID driver's license?
*
Yes
No
Driver's License Number:
*
Driver's License State
*
Can you perform the essential functions of the job you are applying for?
*
Yes
No
May we contact your current employer?
*
Yes
No
Have you ever been employed by Low Voltage NW before?
*
Yes
No
Are you lawfully permitted to work in the United States?
*
Yes
No
Education:
High School
*
1 year completed
2 years completed
3 years completed
4 years completed
Not Applicable / Did Not Attend
College
*
1 year completed
2 years completed
3 years completed
4 years completed
Not Applicable / Did Not Attend
Graduate School
*
1 year completed
2 years completed
3 years completed
4 years completed
Not Applicable / Did Not Attend
CAPTCHA
References:
List (3) references who are not relatives and are familiar with your qualifications and actual work history.
Reference #1 Name
*
Reference #1 Work Relationship
*
Reference #1 Years Known
*
Reference #1 Phone Number
*
Reference #2 Name
*
Reference #2 Work Relationship
*
Reference #2 Years Known
*
Reference #2 Phone Number
*
Reference #3 Name
*
Reference #3 Work Relationship
*
Reference #3 Years Known
*
Reference #3 Phone Number
*
Special Skills, Qualifications, and Considerations
Summarize skills, qualifications, volunteer activities, military experience, employment, or other activities related to the job you are seeking:
Untitled
*
Employment Experience:
Start with your present or most recent job. List your past (4) jobs in order. Do not omit any job.
Employer #1 Name
*
Employer #1 Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Employer #1 Start Date
*
MM slash DD slash YYYY
Employer #1 End Date
*
MM slash DD slash YYYY
Employer #1 Supervisor's Name
*
First
Last
Employer #1 Supervisor's Phone
*
Employer #1 Duties
*
Employer #1 - What did you like about your job?
*
Employer #1 - What did you like least about your job?
*
Employer #1 - Reason for Leaving
*
Employer #2 Name
*
Employer #2 Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Employer #2 Start Date
*
MM slash DD slash YYYY
Employer #2 End Date
*
MM slash DD slash YYYY
Employer #2 Supervisor's Name
*
First
Last
Employer #2 Supervisor's Phone
*
Employer #2 Duties
*
Employer #2 - What did you like about your job?
*
Employer #2 - What did you like least about your job?
*
Employer #2 - What did you like least about your job?
*
Employer #2 - Reason for Leaving
*
Employer #3 Name
*
Employer #3 Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Employer #3 Start Date
*
MM slash DD slash YYYY
Employer #3 End Date
*
MM slash DD slash YYYY
Employer #3 Supervisor's Name
*
First
Last
Employer #3 Duties
*
Employer #3 - What did you like about your job?
*
Employer #3 - What did you like least about your job?
*
Employer #3 - Reason for Leaving
*
Employer #4 Name
*
Employer #4 Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Employer #4 Start Date
*
MM slash DD slash YYYY
Employer #4 End Date
*
MM slash DD slash YYYY
Employer #4 Supervisor's Name
*
First
Last
Employer #4 Duties
*
Employer #4 - What did you like about your job?
*
Employer #4 - What did you like least about your job?
*
Employer #4 - Reason for Leaving
*
Please read the following statements carefully before signing this application. Only applications that are signed and dated are considered valid. If you have any questions regarding this statement, please ask them before signing.
All Answers True?
*
I certify that all answers and statements I have made on this application (and resume or other supplemental materials) are true and complete without omissions. I understand that any false information will be grounds for refusal to hire or for immediate discharge if I am employed. I authorize any of the persons or organizations named in this application to give you complete information and records regarding my employment, education, character, and qualifications.
Yes
No
Responsible for Familiarizing
*
I will be responsible for familiarizing myself with all rules and regulations of the Company as they presently exist or are later modified. I recognize that my employment can be terminated, at the discretion of the Company or at my option, without notice, at any time, except as specifically set forth in writing in a current individual employment agreement signed by the President.
Yes
No
Understanding No Representative
*
I also understand that no representative of the Company has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment, except as specifically stated in a current individual written agreement signed by the President.
Yes
No
I have read, understand and agree with the above.
*
Signature of Applicant
Today's Date
*
MM slash DD slash YYYY
This application is only valid for thirty (30) days from the date I signed. If I want to be considered for job openings more than (30) days from the date signed, I will submit a new application.
Applicant Authorization for Release of Information
I hereby authorize my past employers to release information to Low Voltage NW regarding my employment. This release of information covers my employment record in general, including information on the following questions: Dates of employment; Positions held; The quality and quantity of my work; My attendance habits (excluding workers' compensation, pregnancy, disability, and protected absences); My relationship with co-workers and supervisors; My attitude toward work (cooperative? positive? etc.); Reason for leaving and eligibility for rehire; Strengths and weaknesses; Whether I have had outbursts of temper, threatened, provoked fights with or assaulted others, engaged in hostile or violent behavior, have a criminal record or any traits that would present security or safety issues for others; Other relevant information regarding my performance, skills ability, suitability for employment sought, etc. I agree that all former employers who provide such information are indemnified and released from liability arising from such disclosures. I also understand that if I do not sign this Authorization for Release of Information, my application will be rejected.
Printed Name
*
First
Last
Signature
*
Date
*
MM slash DD slash YYYY
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