Personal Information

First name    Last name    M.I.
Street address
City State/Province  Zip/Postal code
Home Phone    E-mail

Are you at least 18 years old?

 Yes     No   

 Do you have a legal right to work in the United States?

 Yes     No

Are you willing to work overtime?

 Yes     No

 

Employment Desired

What shift are you applying for? 1st 2nd
Full-time or part-time? Full-time Part-time
What position are you applying for?
When can you start? -- dd/mm/yy
Hourly rate desired:
Are you currently employed? Yes     No
 If so, may we contact your employer? Yes     No
Have you ever applied for work at EI Microcircuits? Yes     No
If so, when did you apply? -- mm/yy
Who referred you to EI Microcircuits?

 

Education


Grammar School

Name of school:
Location:
Did you graduate? Yes     No

   

High School

Name of school:
Location:
Did you graduate? Yes     No

Subjects studied:


College

Name of school:
Location:
Number of years attended:
Did you graduate? Yes     No

Subjects studied:


Trade, Business, Correspondence school

Name of school:
Location:
Number of years attended:
Did you graduate? Yes     No

Subjects studied:


 

General

Describe any special studies, training, or research you have done:


Describe any special skills relevant to the position for which you are applying:


Describe any civic, athletic, or other activities you participate in:


 

Previous Employment (beginning with most recent)

#1:

Company Name
Phone
Street address
City
State/Province      Zip/Postal code
Country
Employed From -- mm/yy         Through -- mm/yy
Position
Reason for leaving
Last Wage   $   
May we contact this employer? Yes      No

#2:

Company Name
Phone
Street address
City
State/Province      Zip/Postal code
Country
Employed From -- mm/yy         Through -- mm/yy
Position
Reason for leaving
Last Wage   $   
May we contact this employer? Yes      No

#3:

Company Name
Phone
Street address
City
State/Province      Zip/Postal code
Country
Employed From -- mm/yy         Through -- mm/yy
Position
Reason for leaving
Last Wage   $   
May we contact this employer? Yes      No

References

Give the names of two references not related to you, whom you have known at least one year:

#1:
First name
Last name
Street address
City State/Province Zip/Postal code
Country
Home Phone

#2:
First name
Last name
Street address
City State/Province Zip/Postal code
Country
Home Phone

In case of emergency, notify

First name
Last name
Street address
City State/Province Zip/Postal code
Home Phone

 

i certify that the facts contained in this application are true and complete to the best of my knowledge, and i understand that, if employed falsified statements on this application shall be grounds for dismissal.

i authorize investigation of all statements contained herein and the above references to provide any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you.

i understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.

i understand that the immigration reform and control act of november 6, 1986, requires me to prove the legality of my residency or citizenship. i am also aware that my failure to provide such proof upon request may legally force my termination. to the best of my knowledge, the information contained in this application is true. i understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between me and this company for either employment or the provision of any benefits. I further understand that if an employment relationship is subsequently established, i will have the right to terminate my employment at any time, and the company will have a similar right. in addition, i understand that no promise, representation, or agreement contrary to the foregoing is binding on the company unless made in writing and signed by me and an authorized representative of the company.

by clicking the "submit" button below, you acknowledge that you have read and agree to all of these conditions. if you do not agree, click the "CANCEL" button, then leave this form.

Copyright (c) 2000-2008 EI Microcircuits
Last revised: July 31, 2008