General Personal Information
Today's Date
*
-
Month
-
Day
Year
Full Name
*
Email
*
Present Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Previous Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Format: (000) 000-0000.
Do you have a legal right to be employed in the United States?
*
Yes (Proof Required)
No
Are you over the age of 18?
*
Yes
No
Company Experience
Have you worked for this company before?
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Yes
No
Dates Worked at Pinpoint Fiber?
*
Month/Year - Month-Year
What Pinpoint Fiber location did you work at?
*
Rate of Pay
*
Position
*
Reason for leaving
*
General Work Information
Are you currently employed?
*
Yes
No
When was your last day employed?
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-
Month
-
Day
Year
Position applying for
*
Type of employment
*
Full time
Part time
Temporary
Seasonal
Who referred you?
Rate of pay expected
*
Educational Background
What type of education have you received?
High School
Traditional college
Technical School
What high school did you attend?
*
Name and City
Course or Major
*
Did you graduate?
*
Yes
No
What college did you attend?
*
Name and City
Course or Major
*
Did you graduate?
*
Yes
No
What technical school did you attend?
*
Name and City
Course or Major
*
Did you graduate?
*
Yes
No
Other Notable Education
Present and Past Employment
Company Name
*
Company Name Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Company Phone Number
*
Format: (000) 000-0000.
Type of Business
*
Name of Supervisor
*
Starting Base Gross Income
*
Type of pay
*
Hourly
Yearly
Did you receive extra pay?
*
Bonus
Incentive
Amount Received
*
Hours Worked
*
Dates Worked
*
Hours Worked
*
Position Held
*
Duties/Responsibilities
*
Reason for Leaving
*
Do you want to add another previous job?
*
Yes
No
Company Name
*
Company Name Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Company Phone Number
*
Format: (000) 000-0000.
Type of Business
*
Name of Supervisor
*
Starting Base Gross Income
*
Type of pay
*
Hourly
Yearly
Did you receive extra pay?
*
Bonus
Incentive
Amount Received
*
Hours Worked
*
Dates Worked
*
Hours Worked
*
Position Held
*
Duties/Responsibilities
*
Reason for Leaving
*
Work References
Name of First Reference
*
Company
*
Work Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Format: (000) 000-0000.
Years Known
*
Relationship and Title
*
Name of Second Reference
*
Company
*
Work Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Format: (000) 000-0000.
Years Known
*
Relationship and Title
*
Do you want to add another reference?
*
Yes
No
Name of Third Reference
*
Company
*
Work Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
*
Format: (000) 000-0000.
Years Known
*
Relationship and Title
*
Special Skills
Words Per Minutes
*
Please check the skills for which you have recieved training:
Word Processing
Data Entry
10 - Key Calculator
Software Packages
Programming Languages
Database
Manufacturing Equipment
Describe training or experience you've had in the skills listed above:
APPLICANT MUST READ AND SIGN: I certify that I have read and understood all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of the employer. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
Date
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