Careers - Kanson Electronics

Position Applied For

Today's Date (Required)

Last Name (Required)

First Name (Required)

Middle Initial

Current Address: Street, City, State, Zip (Required)

Home Phone (Required)

Cell Phone (Required)

Social Security Number

Are You Age 18 or Over? (Required)

Yes No

What Date Can You Start?

What category would you prefer?

Full Time Part Time Temporary Seasonal

GED/Diploma Received?

Yes No

Issued By

If your school records are under a different name than listed on page 1, please enter that name

Other Schools or Training (Trade, Vocational, Armed Forces, or Business) Give Name and Location of Each School, Subjects Studied, Certificates, and Any Other Pertinent Data

Special Qualifications and Skills (Licenses, skills with machines, computer skills, patents or inventions, publications, public speaking, professional or scientific societies, typing or shorthand speed, honors, awards, and fellowships, foreign languages, etc.)

Do you have military service?

Yes No

Branch of Service

Military Duties

Do you have any Licenses/Certifications relevant to the job applied for?

Yes No

Name of Licenses/Certifications

License/Certification Number

Issuing State

Has your License/Certification ever been revoked or suspended?

Yes No

If yes, state the reason(s), date of revocation or suspension, and date of reinstatement

Previous Employers

Most Recent Employer

Are you currently working for this employer?

Yes No

If yes, may we contact?

Yes No

Company Name

City

State

Start Date

End Date

Job Title

Supervisor Name

Phone

Salary

Reason For Leaving

Duties

Most Recent Employer

Are you currently working for this employer?

Yes No

If yes, may we contact?

Yes No

Company Name

City

State

Start Date

End Date

Job Title

Supervisor Name

Phone

Salary

Reason For Leaving

Duties

Most Recent Employer

Are you currently working for this employer?

Yes No

If yes, may we contact?

Yes No

Company Name

City

State

Start Date

End Date

Job Title

Supervisor Name

Phone

Salary

Reason For Leaving

Duties

If job requires, do you have a valid driver's license

Yes No

Driver's License Number

Type

State of Issue

Are you eligible to work in the United States? (Proof of eligibility will be required before you can be employed)

Yes No

Have you been convicted of a felony within the last 7 years?

Yes No

If yes, explain (Conviction will not necessarily disqualify you for employment)

LIST 3 PERSONS WHO ARE NOT RELATED TO YOU AND WHO HAVE DEFINITE KNOWLEDGE OF YOUR BUSINESS OR PROFESSIONAL QUALIFICATIONS FOR THE POSITION FOR WHICH YOU ARE APPLYING. DO NOT REPEAT NAMES OF SUPERVISORS LISTED UNDER WORK HISTORY. LABOR AND WORKFORCE DEVELOPMENT DOES NOT VERIFY REFERENCES, BUT EMPLOYERS UTILIZING THIS APPLICATION MAY.

First Reference

Name

Phone Number

Business or Home Address

Business or Occupation

Second Reference

Name

Phone Number

Business or Home Address

Business or Occupation

Third Reference

Name

Phone Number

Business or Home Address

Business or Occupation

APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment. This application form is not an offer of employment. If hired, such employment shall be considered “at will” and this application is not intended to constitute a contract of continued employment. False or misleading statements during the interview or on this form may result in the refusal to hire or termination of employment. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability, or any other consideration made unlawful by applicable federal, state or local laws. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you may be required to complete a medical history form and may be required to be examined by a medical professional designated by the company. Smoking is prohibited in all indoor areas of the Company's facilities unless designated smoking areas have been established at a particular location in accordance with applicable state and local law.

CERTIFICATION AND RELEASE: I certify that I have read and understand the applicant note on this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I release all former employers, persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

Electronic Signature

Date