Application for Employment

Contact Information •  Employment-Related •  Employment Experience •  Education

Electronic Systems, Inc. is an Equal Opportunity Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, or disability.

Only completed applications will be further reviewed and considered.
Incomplete applications will be disregarded.


Saturday, July 21, 2018

Contact Information

                        First                         Middle                         Last                        Preferred Name
Name:
E-Mail Address:
Phone Number: 999-999-9999 Times you can be reached:
Mobile Number: 999-999-9999 Times you can be reached:
Address 1:
Address 2:
City:
State:
Zip Code:

Employment-Related  Top

Positions Applied For: Day Shift Evening Shift  
Rate of Pay Expected: to
On what date would you be available for work?
Referral Source: Advertisement Friend Relative Walk-in Employment Agency
  Other
  Current ESI Employee If so, give name:
Are you 18 or older? Yes No
Have you filed an application here before? Yes No If yes, give date:
Have you ever been employed here before? Yes No If yes, give date:
Have you ever been employed here through a contract agency? Yes No
If yes, give agency name and date:
Are you employed now? Yes No
Are you eligible to work in the United States? Yes No
Proof of eligibility will be required when/if an offer of employment is made.
Are you a United States Citizen and/or Permanent Resident and/or Political Asylee? Yes No
Proof will be required when/if an offer of employment is made.
Are you able to functionally read and comprehend written English? Yes No
Are you able to effectively speak and fully understand spoken English? Yes No
Have you been convicted of a felony within the last 7 years? Yes No
If yes, please explain:
Conviction will not necessarily disqualify applicant from employment.
This information will only be used for job-related purposes and only to the extent allowed by law.
Do you hold any professional certification or licensure? Yes No
If yes, describe, list dates issued and expiration dates:
List three references who are not related to you and are not previous employers:

Name                                       Address                                                          Phone
Are you able to perform the functions of the position for which you are applying? Yes No
With or without accomodation
Summarize special skills and qualifications acquired from employment or other experience:

Employment Experience  Top

Start with your present or last job. Include applicable military service. Exclude organization names indicating race, color, religion, sex or national origin. We reserve the right to contact employers unless you indicate otherwise.

Employer 1: Phone Number: 999-999-9999
Address: street, city, state, zip
Job Title:
Supervisor:
Reason for Leaving:
Employment Started On: Employment Ended On:
Starting Hourly Rate or Salary: Ending Hourly Rate or Salary:
Briefly describe work performed:
May we contact this employer? Yes No
If no, provide reason:

Employer 2: Phone Number: 999-999-9999
Address: street, city, state, zip
Job Title:
Supervisor:
Reason for Leaving:
Employment Started On: Employment Ended On:
Starting Hourly Rate or Salary: Ending Hourly Rate or Salary:
Briefly describe work performed:
May we contact this employer? Yes No
If no, provide reason:

Employer 3: Phone Number: 999-999-9999
Address: street, city, state, zip
Job Title:
Supervisor:
Reason for Leaving:
Employment Started On: Employment Ended On:
Starting Hourly Rate or Salary: Ending Hourly Rate or Salary:
Briefly describe work performed:
May we contact this employer? Yes No
If no, provide reason:

Employer 4: Phone Number: 999-999-9999
Address: street, city, state, zip
Job Title:
Supervisor:
Reason for Leaving:
Employment Started On: Employment Ended On:
Starting Hourly Rate or Salary: Ending Hourly Rate or Salary:
Briefly describe work performed:
May we contact this employer? Yes No
If no, provide reason:

Education  Top

High School:
Year completed: 9th 10th 11th 12th GED
Diploma/Degree:
Describe course of study or applicable course work:
 
Describe any specialized training, apprenticeship skills and extra-curricular activities::
 

College/University:
Year completed: 1st 2nd 3rd 4th
Diploma/Degree:
Describe course of study or applicable course work:
 
Describe any specialized training, apprenticeship skills and extra-curricular activities::
 

Graduate/Professional:
Year completed: 1st 2nd 3rd 4th
Diploma/Degree:
Describe course of study or applicable course work:
 
Describe any specialized training, apprenticeship skills and extra-curricular activities::
 

Honors Received:

State any additional information you feel may be helpful to us in considering your application.:

Upload résumé:
 Optional. Up to 11 MB (11264 KB) with doc, docx, pdf, rtf, txt extensions

I certify that answers given herein are true and complete to the best of my knowledge and authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand my employment is conditional upon a satisfactory background report which will include a criminal background check. I understand that this application is not a contract of employment.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may likely result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand and agree that if hired, my employment is at will and that under state law I have the right to terminate my employment at any time and for any reason and that Electronic Systems, Inc. has the same right to terminate my employment at any time and for any reason.


Your Full Name:
                             Entering your name will be considered as valid as an actual signature.

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