Employment Application Form for QuirkWire

Employment Application Form for QuirkWire

Please complete all sections accurately. Use the 'Save and Continue Later' feature if needed.
Quirk Wire is an equal opportunity employer. All applicants are considered without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, pregnancy or related conditions, marital status, genetic information, national origin, age, disability, military or veteran status, Vietnam Era Veteran status, membership in the Reserves or National Guard, or any other characteristic protected by federal, state, or local law.

Quirk Wire is committed to ensuring access, equal opportunity, and reasonable accommodations for qualified applicants and employees with disabilities. To request accommodation during the application or employment process, please contact the Human Resources Department at 508-867-3155.

Important Notice (Massachusetts Law):
It is illegal in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. Employers who violate this law are subject to criminal penalties and civil liability.
Date of Application*

MonthDayYear
Date
Position(s) Applied For*
Referral Source*
If “Other”, specify
Last Name, First Name, Middle Name*

First NameMiddle NameLast Name
Home Telephone*
Please enter a valid phone number.
Cellphone*
Please enter a valid phone number.
Preferred Contact Number*
Email Address*
example@example.com
Are you under 18?*

YesNo
Have you applied here before?*

YesNo
Have you been employed here before?*

YesNo
Are you currently employed?*

YesNo
May we contact your present employer?*

YesNo
Date available to start*

MonthDayYear
Date
Availability to work*

Full-timePart-timeOvertime
Are you on lay-off and subject to recall?*

YesNo
Can you travel if the job requires it?*

YesNo
Please list three references not related to you. Previous employers preferred.*
Reference 1 Name*
Reference 1 Address*
Reference 1 Phone Number*
Please enter a valid phone number.
Reference 2 Name*
Reference 2 Address*
Reference 2 Phone Number*
Please enter a valid phone number.
Reference 3 Name*
Reference 3 Address*
Reference 3 Phone Number*
Please enter a valid phone number.
Employer Name*
Start Date of Employment*

MonthDayYear
Date
End Date of Employment*

MonthDayYear
Date
City, State, Zip*
Employer Phone Number*
Please enter a valid phone number.
Job Title*
Fax (optional)
Supervisor Name*
Work Performed*
Reason for Leaving*
Special Skills or Qualifications
Name of School*
Years Completed*
Diploma or Degree*
Course of Study*
Specialized Training, Apprenticeships, Skills, Extra Curricular Activities
Employment Agreement and Acknowledgment*
By signing below, I acknowledge that I understand this employment application, or the granting of an oral interview, does not constitute a contract of employment or a guarantee of future benefits by this company/organization. I further understand and agree that if I am hired, my employment will be at-will, meaning it may be terminated at any time, with or without cause, by either myself or my employer. I also understand that this written statement overrides any and all oral representations made by agents or representatives of the company/organization.

I certify that all information provided on this application is true, complete, and accurate. I authorize the investigation of my prior employment, education, and other relevant activities, and I release from liability all individuals, companies, and organizations providing such information. I understand that any false answers, misstatements, or significant omissions on this form may be grounds for denial of employment or termination.
Signature

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Date Signed*

MonthDayYear
Date
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