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APPLICATION FOR EMPLOYMENT – PLEASE PRINT|
Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify the Human Resource Department. |
ALL APPLICANTS ARE SUBJECT TO PRE-EMPLOYMENT DRUG TESTING, REFERENCE CHECKS, AND BACKGROUND VERIFICATIONS.
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| If you are under 18, and it is required, can you furnish a work ....................................................................... | Yes No | |||||
| If no, please explain | ||||||
| Have you ever been employed here before?................................................................................................... | Yes No | |||||
| If yes, give dates and positions | ||||||
| Are you legally eligible for employment in this country? ............................................................................................. | Yes No | |||||
| Date available for work ___________ What is your desired salary range? ....................... | ||||||
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| Are you able to meet the attendance requirements of the position? ................................................................. | Yes No | |||||
| Have you ever pled “guilty” or “no contest” to or been convicted of a crime? ................................................. | Yes No | |||||
| If yes, please provide date(s) and details: | ||||||
ANSWERING “YES” TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT. FACTORS, SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR, WILL BE TAKEN INTO ACCOUNT.
Driver’s license number _______________________ State _______
| Employment History |
| FROM | TO | EMPLOYER | TELEPHONE # |
| STARTING JOB TITLE/FINAL JOB TITLE | ADDRESS | ||
| IMMEDIATE SUPERVISOR AND TITLE | SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES | ||
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MAY WE CONTACT FOR REFERENCE? YES NO LATER |
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| REASON FOR LEAVING | HOURLY RATE/SALARY
START $ _________ PER _________ FINAL $ _________ PER _________ |
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| FROM | TO | EMPLOYER | TELEPHONE # |
| STARTING JOB TITLE/FINAL JOB TITLE | ADDRESS | ||
| IMMEDIATE SUPERVISOR AND TITLE | SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES | ||
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MAY WE CONTACT FOR REFERENCE? YES NO LATER |
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| REASON FOR LEAVING | HOURLY RATE/SALARY
START $ _________ PER _________ FINAL $ _________ PER _________ |
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| FROM | TO | EMPLOYER | TELEPHONE # |
| STARTING JOB TITLE/FINAL JOB TITLE | ADDRESS | ||
| IMMEDIATE SUPERVISOR AND TITLE | SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES | ||
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MAY WE CONTACT FOR REFERENCE? YES NO LATER |
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| REASON FOR LEAVING | HOURLY RATE/SALARY
START $ _________ PER _________ FINAL $ _________ PER _________ |
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Skills and Qualifications |
| Summarize any training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying. |
Educational Background (if job-related) |
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NAME AND LOCATION |
NUMBER OF YEARS |
DID YOU GRADUATE? |
COURSE OF STUDY |
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| HIGH SCHOOL | ||||
| COLLEGE | MAJOR | DEGREE | ||
| OTHER | ||||
References (3) |
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NAME |
TELEPHONE |
NUMBER OF YEARS KNOWN |
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Applicant Statement |
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I understand that any information provided by me is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice; and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that Homeland Security immigration laws require me to complete a Form I-9 in this regard.
I UNDERSTAND THE SAFETY REASONS FOR THIS COMPANY HAVING A Drug and Alcohol Policy/Program. I realize that I will be subject to pre-employment testing. I understand that strict processing procedures for the drug and alcohol testing will be followed and agree that the results will be forwarded to tECHCORR USA for my application’s continued consideration.
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DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Signature of Applicant _________________________________ DATE _______________ |
TECHCORR USA IS AN EQUAL OPPORTUNITY EMPLOYER
Voluntary Disclosure Form
(Detach from Application and Submit Separately)
(Completion is Entirely Voluntary and NOT a Requirement for Employment)
Various agencies of the Unites States Government require employers to maintain information on applicants pertaining to factors such as race, sex and type of position applied for. The information requested is for the purpose of Techcorr Engineering and Inspection compliance with these record-keeping requirements. Techcorr Engineering and Inspection believes all persons are entitled to equal employment opportunities and does not discriminate against its employees or applicants for employment on the basis of race, religious creed, ancestry, color, sex, national origin, citizenship, marital status, religion, age, disability, sexual orientation, and military status or any other condition or characteristic protected by applicable law.
Date: __________________________
Position(s) Applied For: _______________________________________________________________
Requisition Number(s): _______________________________________________________________
Race/Ethic Identification (Please identify your race or ethnicity as defined below :)
America Indian or Alaskan Native- A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.
Asian- A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American- A person having origins in any of the Black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black or American”.
Native Hawaiian or Other Pacific Islander- A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White- A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Hispanic or Latino (All races)- A person of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, regardless of race.
Hispanic or Latino (White race only)- A person of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, and of the White race.
Hispanic or Latino (all other races)- A person of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, and of any race other than White.
Other-_____________________________________________________________________________
GENDER: Male Female
VETERAN STATUS: Special Disabled Vietnam Era
Other Veteran (Campaign badge was authorized)
Recently Separated Veteran (Past 12 months)