Connected Technology Application for Employment

Full Name *

First Name Middle Initial Last Name

Current Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Email Address *

Daytime phone number *

Area Code Phone Number

Evening phone number (if different)

Area Code Phone Number

Position Applying for *

Your Current Qualifications

	Training or certification	Institution or training provider	Year completed
1
2
3

Do you have a Journeyman's license? *

Yes No

If yes, Journeyman's License #:

Professional licenses or certifications:

Are you currently undertaking study or training? *

Yes No

If yes, course/program name:

Your Previous Employment

	Employer/establishment	Position held	Dates to/from	Reason for leaving
1
2
3

References

	Name	Phone Number	Position held or relationship
1)
2)
3)

May we contact your references? (information will be used ethically and kept confidential) *

Yes No

Are you able to pass a background check? *

Yes No

Are you willing to take a drug test? *

Yes No

When will you be available for work? *

Please provide any other information that you identify as being pertinent to this application.

If you'd like to include your resume, please upload it here.

Browse Files

(.doc and .pdf file formats are accepted)

Declaration

I declare that, to be best of my knowledge, the information given is true and correct. I understand that inaccurate, misleading or untrue statements or knowlingly withheld information may result in termination of employment with Connected Technology. I understand that in some cases police and credit checks may be required and I will be notified if this applies to this application.

Please verify that you are human by typing the text into the box: *