EBW Electronics Employment Application

Applicant Data

Position Applied For*:

Date:

First Name*:

Last Name*:

Address*:

City*:

State*:

Zip*:

Home Phone:

Cell Phone:

Email*:


Shifts Open*:
 first second third

Type of Employment:
 full-time part-time temporary

Are you available for overtime?:
 yes no

How did you hear about this position?:

If Employee Referral, please enter referral name:

What is your desired salary range?:

First Available Date:


Education


Highest level of education completed?*

Please list information regarding most recent education received:

School Name:

Years Completed:

Diploma/Degree Received:

Note:



School Name:

Years Completed:

Diploma/Degree:

Note:



Additional Skills/Knowledge/Certifications:

Are you over the age of 18?*:

Have you ever worked for EBWE?*:

If yes, when?

Are you eligible to work in the US*?

Have you ever been convicted of a felony or misdemeanor?*:

If yes, please explain:

*Please note that answering yes to this question does not constitute an automatic rejection for employment.


Employment History


Start with most recent position; Must complete at least 1 most recent even if attaching a resume.

Company Name*:

Date Started*:

Date Ended:

Job Title*:

Pay Rate $:

Location:

Status*:
 full-time part-time temporary

Supervisor:

Supervisor Title*:

Responsibilities:

Reason for Leaving*:

May we contact this employer for reference?*



Company Name 2:

Date Started:

Date Ended:

Job Title:

Pay Rate $:

Location:

Status:
 full-time part-time temporary

Supervisor:

Supervisor Title:

Responsibilities:

Reason for Leaving:

May we contact this employer for reference?



Company Name 3:

Date Started:

Date Ended:

Job Title:

Pay Rate $:

Location:

Status:
 full-time part-time temporary

Supervisor:

Supervisor Title:

Responsibilities:

Reason for Leaving:

May we contact this employer for reference?



Company Name 4:

Date Started:

Date Ended:

Job Title:

Pay Rate $:

Location:

Status:
 full-time part-time temporary

Supervisor:

Supervisor Title:

Responsibilities:

Reason for Leaving:

May we contact this employer for reference?


References


Name:

Phone:

Years Known:

Occupation:

Relationship:

Best time to call:


Reference 2:

Phone:

Years Known:

Occupation:

Relationship:

Best time to call:


Reference 3:

Phone:

Years Known:

Occupation:

Relationship:

Best time to call:

Applicant’s Statement


READ THE FOLLOWING STATEMENTS CAREFULL BEFORE SIGNING AND DATING

I certify that the information in this application is true and complete to the best of my knowledge and I understand that deliberate falsification of this information is grounds for refusal to hire or dismissal from employment.

I recognize that neither this application, nor any future employment is an employment contract. I recognize that if I become employed, my employment will be at-will and for no definite period of time. I will be free to terminate my employment at any time for any reason, and the Company retains the same right. Only the president has the authority to make any contrary agreements.

I understand that EBW Electronics, Inc. will conduct Criminal History checks following an offer of employment. Failure to accurately and thoroughly disclose a criminal record history will be grounds for disciplinary action, including dismissal, at any time after it is discovered. Based on EBWE’s policy a criminal record may also disqualify me from further consideration.

I understand that EBW Electronics, Inc. will check references offered by myself and that it is their objective to obtain information on ability and previous job performance for the sole purpose of considering me for employment. I hereby authorize any person named by myself as a reference, prior employer, or an educational institution to submit information or opinions about me in order to evaluate my employment qualifications.

I understand that EBW Electronics is a drug free work place and therefore will require a pre-employment medical screening before officially beginning work for EBW Electronics. I fully understand that the results of this test could disqualify me from further consideration.

Signature:

Please type your full name and date to signify that you're read the above 'Applicant's Statement'.

Name*:
Date*:

Voluntary Identification Form


Anti-discrimination Notice: It is an unlawful employment practice for an employer to fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to that individual’s terms and conditions of employments, because of such individual’s race, color, religion, sex or nation origin.

Submission of this information is voluntary and for reporting purpose only. Refusal to provide this information will not subject you to any adverse treatment. The information will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that required the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Please read ALL above 'Voluntary Identification' instructions carefully before completing this section of the form.

Sex*:

What is your race/ethnicity?*
You may select only one:



Optional Resume Upload:

Optional Cover Letter Upload: