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Personal information

First Name:

Address:

Home phone:

Social security No:

Position applied for:

Employment desired:

Full time

Part-time

Temporary seasonal

Date available to start:

How many hours can you work weekly:

Are You Legally Eligible for Employment in this Country?

Yes

If under the age of 18, do you have a work permit?

Yes

Last Name

City:	State	Zip

Alternate phone:

Drivers License No / State:

Salary desired:

Judicial Information

HAVE YOU EVER BEEN CONVICTED OF A FELONY WITHIN THE LAST 7 YEARS?

Yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Education

Complete la información según los estudis realizados.

Type of school

High school

College

Bus. or trade school

Professional School

Name of school

Location

No. of years completed

Major & Degree

Personal Information

Do you have the physical ability to perform all essential duties of the job(s) for which you are applying?

Yes

If no, please explain:

Are there workplace accommodations, which would assure better job placement and/or enable you to perform your job to you maximum capacity?

Yes

If yes, please explain:

Please list two personal or business references other than relatives or previous employers.

Name:

Position:

Company:

Address:

Telephone:

Name

Position:

Company:

Adress:

Telephone:

Work Experience

Please list your work experience for the past four employers, starting with the most recent position. If you were self-employed, give firm name. Provide specific information for all areas listed.

May we contact your present employer?

Yes

Employer:

Address:

Telephone:

Hourly Rate/Salary - Start:

Ending:

From:	To:

Position:

Supervisor:

Per:

Per:

Reason for Leaving:

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?

Yes

Employer:

Address:

Telephone:

Hourly Rate/Salary - Start:

Ending:

From:	To:

Position:

Supervisor:

Per:

Per:

Reason for Leaving:

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?

Yes

Employer:

Address:

Telephone:

Hourly Rate/Salary - Start:

Ending:

From:	To:

Position:

Supervisor:

Per:

Per:

Reason for Leaving:

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

Additional Information

An application form sometimes makes it difficult for an individual to adequately 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.

APPLICANT STATEMENT

I certify that all the information I have provided in order to apply for and secure work with Silmar Electronics, Inc. is true, complete and correct.

I expressly authorized, without reservation, Silmar Electronics, Inc., its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwiseverify the accuracy of all information provided by me in this application for employment or during my job interview. I hereby waive any and all rights and claims I may have regarding Silmar Electronics, its agents, employees or representatives for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that Silmar Electronics, Inc. has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; consent to and compliance with such policy is a condition of my employment; and continued employment is based on the successful passing of testing under such policy.

I understand that, in connection with the routine processing of my employment application, Silmar Electronics, Inc. may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, pesonal characteristics, and mode of living. Upon written request from me, Silmar Electronics, Inc. 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 understand that Silmar Electronics, Inc. does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and Silmar Electronics, Inc. reserves the right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the forgoing express language are valid unless they are in writing and signed by the Director of Human Resources or the President/CEO of Silmar Electronics, Inc.

I also understand that if I am hired, I will be required to complete a 90 day introductory period of evaluation. Upon the completion of this introductory period I will be subject to the same terms and conditions of employment identified in the Employee Handbook and company Policies & Procedures. I also understand that I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant: Date:

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