Application for Employment

Date of Application*

First Name*

Middle Name

Last Name*

Email*

Please indicate any other name(s) you have been known by

Street Address*

Apt #

City, State. Zip*

SSN*

Home Telephone

Cell Phone*

Specific position desired *

Starting Pay Range Expected *

_____________to______________

REFERRAL SOURCE (Please check all that apply)*

Advertisement (Specify) *

Employment Agency/Search Firm (Specify) *

Have you ever filed an application with us before?*

YesNo

If yes, give date

What type of employment are you interested in?*

Full TimePart TimeTemporaryInternship

Are you willing to work overtime?*

YesNo

Are you willing to travel out of town?*

YesNo

If so, what percentage of time?*

On what date would you be available to start work?*

Are you legally eligible to work in the U.S.?*

YesNo

If you are hired, you will be required to furnish documentation within 3 working days showing your are authorized to work in the U.S.

Have you been convicted of any crime?*

YesNo

Conviction will not necessarily disqualify an applicant from employment and will only be considered in relation to specific job requirements.

Year*

Jurisdiction *

Please explain in detail*

Name and Location of High School*

Number of Years Completed*

Major/Course of Study*

Degree or Diploma*

YesNo

Name and Location of Secondary

Number of Years Completed

Major/Course of Study

Degree or Diploma

YesNo

Do you want to list another Secondary Education?*

YesNo

Name and Location of Secondary

Number of Years Completed

Major/Course of Study

Degree or Diploma

YesNo

Do you want to list another Secondary Education?

YesNo

Name and Location of Secondary

Number of Years Completed

Major/Course of Study

Degree or Diploma

YesNo

List other special skills or training (languages, machine operation, office equipment, typing speed, etc.) relevant to the position for which you are applying:*

Reference #1 Name/Title *

Business Phone *

Business Relationship *

Years Acquainted *

Home Phone *

Reference #2 Name/Title

Business Phone

Business Relationship

Years Acquainted

Home Phone

Reference #3 Name/Title

Business Phone

Business Relationship

Years Acquainted

Home Phone

State names of relatives and/or friends who have been, or are, employed by Panora Fiber and the relationship of this person to you, (i.e., mother, father, step-parent, aunt, cousin, nephew, etc).

If you are currently employed, may we contact your employer?*

YesNo

Name of most recent/current employer *

Start Date*

Ending Date*

Address *

Starting Salary *

Ending Salary *

Name and Title of Immediate Supervisor *

Telephone *

State Job Title and Describe the Responsibilities of Your Position *

Reason(s) for Leaving *

2) Name of most recent/current employer

Start Date

Ending Date

Address

Starting Salary

Ending Salary

Name and Title of Immediate Supervisor

Telephone

State Job Title and Describe the Responsibilities of Your Position

Reason(s) for Leaving

3) Name of most recent/current employer

Start Date

Ending Date

Address

Starting Salary

Ending Salary

Name and Title of Immediate Supervisor

Telephone

State Job Title and Describe the Responsibilities of Your Position

Reason(s) for Leaving

Upload Resume

(Read Carefully Before Signing)

I here by authorize Panora Fiber to conduct an investigation concerning all statements made in my application and to conduct any other investigation the Company deems appropriate, including a review of my driving history (if job related), and criminal conviction history. I request any duly constituted law enforcement agencies or judicial officers and all other entities to furnish the Company with all information requested for its investigation of my background and qualifications. I hereby release the Company and all individuals and entities from any and all liability arising from disclosure of the information obtained during such an investigation.

I understand that my previous and present employer may be asked for information relative to my employment record with them, unless otherwise requested. I hereby release from all liability or damage those individuals or corporations who provide information relating to my prior employment or character, and I authorize Panora Fiber to make any investigation it may deem advisable with no liability arising therefrom. I agree that any false statements made by me or my failure to answer any applicable questions on this application completely, regardless of when discovered, will be sufficient cause for my release from employment.

Additionally, I understand that nothing contained in the employment application or in the granting of an interview is intended to create an employment contract for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding unless made in writing. IF ANY EMPLOYMENT RELATIONSHIP IS ESTABLISHED, I UNDERSTAND THAT I HAVE THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME. I FURTHER UNDERSTAND THAT I WOULD BE AN EMPLOYEE AT WILL AND THAT PANORA FIBER CAN TERMINATE MY EMPLOYMENT AT ANY TIME WITH OR WITHOUT NOTICE AND WITH OR WITHOUT CAUSE.

Signature*

Date*

Application for Employment

Education

Skills

References

Required Information

Employment

Resume

Certification