Application for Employment

Position Applied For

Position TitleLocation

Name

First NameMiddle InitialLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone #

Area CodePhone Number

Home Phone #

Area CodePhone Number

Work Phone #

Area CodePhone Number

Email

example@example.com

How did you find out about this job opening?

Are you authorized to work in the U.S.? (If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.)

Have you ever been employed by US Cellular?

Have you ever been convicted of a felony? If yes, please describe condition.

Date available for employment?

Hours available to work?

Education - List most recent first (use extra fields provided if applicable)

Name of College or University

Type of Degree

Date AttendedMajor/Hours

Date of Completion

Name of College or University

Type of Degree

Date AttendedMajor/Hours

Date of Completion

Name of High School

Extra Curricular

Date Attended

Date of Completion

Professional & Community Involvement - List most relevant (use extra fields provided if applicable)

Name of Organization

Position or Type of Activity

Duration of InvolvementAwards/Recognition

Reason for Ending Involvement

Name of Organization

Position or Type of Activity

Duration of InvolvementAwards/Recognition

Reason for Ending Involvement

Employment History – List all employment including military and volunteer service starting with the most current position held. Show employment history for at least 10 years or from the time you left school. Explain gaps in employment history. You may attach a resume, but you must complete the employment section. This Application for Employment information will be used in reference checks. Failure to answer all items in the following section may eliminate you from further consideration.

Upload Resume

Position Title

Organization Name/Address

Dates Employed (month/year)

From:To:

If Part-time, how many hours?

Salary

Start Rate Per HourFinal Rate Per Hour

Duties

Reason for Leaving

Supervisor's Name/Title/Phone

May we contact for references?

Position Title

Organization Name/Address

Dates Employed (month/year)

From:To:

If Part-time, how many hours?

Salary

Start Rate Per HourFinal Rate Per Hour

Duties

Reason for Leaving

Supervisor's Name/Title/Phone

May we contact for references?

Position Title

Organization Name/Address

Dates Employed (month/year)

From:To:

If Part-time, how many hours?

Salary

Start Rate Per HourFinal Rate Per Hour

Duties

Reason for Leaving

Supervisor's Name/Title/Phone

May we contact for references?

Position Title

Organization Name/Address

Dates Employed (month/year)

From:To:

If Part-time, how many hours?

Salary

Start Rate Per HourFinal Rate Per Hour

Duties

Reason for Leaving

Supervisor's Name/Title/Phone

May we contact for references?

References – At minimum, list current supervisor and/or academic advisor and two professional/academic references. In addition to work references indicated in the employment history section, the following references may be contacted.

Name

Type of Reference

Occupation & Company

Address (Street, City, State, Zip)

Telephone & Email Address

Name

Type of Reference

Occupation & Company

Address (Street, City, State, Zip)

Telephone & Email Address

Name

Type of Reference

Occupation & Company

Address (Street, City, State, Zip)

Telephone & Email Address

In the box below, please briefly indicate other information about your professional or academic background and career goals which could be pertinent to an employment decision.