Employment Application * INDICATES REQUIRED FIELDFIRST NAME* MI* LAST NAME* PREFERRED NAME / NICKNAME Address* Street Address APT # City State / Province / Region ZIP / Postal Code CELL PHONE*HOME / ALTERNATE PHONE*Email* PLEASE PROVIDE A RESPONSE TO THE FOLLOWINGPOSITION DESIRED:* WHEN ARE YOU ABLE TO START WORK?* ARE YOU INTERESTED IN:*Full TimePart TimeTemporaryWHAT SCHEDULE WOULD YOU PREFER?*WeekdaysWeekendsEveningsNightsHOW DID YOU HEAR ABOUT THE POSITION?*Classified AdRadioInternetFriendNAME OF REFERRAL* DESIRED PAY HOURLY* ANNUAL PAY MINIMUM* IN WHAT LOCAL AREA DO YOU PREFER TO WORK?* DESIRED ANNUAL PAY* PLEASE CHECK YES OR NO TO THE FOLLOWING:ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES* Yes No Federal law requires that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with these laws, Switch Electric Inc will verify the status of every individual offered employment with the Company. In this connection, all offers of employment are subject to verification of the applicant’s identity and employment authorization, and it will be necessary for you to submit such documents as are required by law to verify your identification and employment authorization.ARE YOU UNDER 18 YEARS OF AGE* Yes* No *IF YES, CAN YOU PROVIDE A WORK PERMIT?* Yes No ARE YOU CAPABLE OF PERFORMING THE ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING WITH OR WITHOUT A REASONABLE ACCOMMODATION?* Yes No PLEASE LIST YOUR WORK EXPERIENCE BELOW (MOST RECENT JOB FIRST)DATES WORKED* COMPANY NAME* YOUR POSITION AND TITLE* TYPE OF BUSINESS* PHONE NUMBER*SUPERVISORS NAME* Address* Street Address City State / Province / Region ZIP / Postal Code TERMINATION* Voluntary Involuntary REASON* BRIEFLY DESCRIBE YOUR MAJOR DUTIES*Second Most Recent Job HistoryDATES WORKED* COMPANY NAME* YOUR POSITION AND TITLE* TYPE OF BUSINESS* PHONE NUMBER*SUPERVISORS NAME* Address* Street Address City State / Province / Region ZIP / Postal Code TERMINATION* Voluntary Involuntary REASON* BRIEFLY DESCRIBE YOUR MAJOR DUTIES*Third Most Recent Job HistoryDATES WORKED COMPANY NAME YOUR POSITION AND TITLE TYPE OF BUSINESS PHONE NUMBERSUPERVISORS NAME Address Street Address City State / Province / Region ZIP / Postal Code TERMINATION Voluntary Involuntary REASON BRIEFLY DESCRIBE YOUR MAJOR DUTIESEDUCATION:High School or PrepNAME AND ADDRESS* MAJOR / SUBJECT* DID YOU GRADUATE?* TYPE OF DEGREE OR DIPLOMA* CollegeNAME AND ADDRESS MAJOR / SUBJECT DID YOU GRADUATE? TYPE OF DEGREE OR DIPLOMA OtherNAME AND ADDRESS MAJOR / SUBJECT DID YOU GRADUATE? TYPE OF DEGREE OR DIPLOMA OtherNAME AND ADDRESS MAJOR / SUBJECT DID YOU GRADUATE? TYPE OF DEGREE OR DIPLOMA REFERENCESPlease list three professional references (Other than the provided contacts under the section "Work Experience")NAME* POSITION* COMPANY* PHONE NUMBER*NAME* POSITION* COMPANY* PHONE NUMBER*NAME* POSITION* COMPANY* PHONE NUMBER*PLEASE READ CAREFULLY BEFORE SUBMITTINGI have submitted the attached form to the company for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate the company to further process my application. My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials, is true and complete to the best of my knowledge and also constitutes authority to verify any and all information submitted on this application. I understand that any misrepresentation or omission of any fact in my application, resume or any other materials, or during any interviews, can be justification for refusal of employment, or, if employed, termination from the Company’s employ. I also affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of employment with the Company in the position I am seeking. I understand that this application is not an employment contract for any specific length of time between the Company and me, and that in the event I am hired, my employment will be “at will” and either the Company or I can terminate my employment with or without cause and with or without notice at any time. Nothing contained in any handbook, manual, policy and the like, distributed by the Company to its employees is intended to or can create an employment contract, an offer of employment or any obligation on the Company’s part. The Company may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy practice, condition or process affecting its employees. References: I hereby authorize the company and its agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize the company and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.SIGNED NAME* DATE*
