A.C.C.I.

ON STAFF

Application for Employment

We consider applicants for all positions without regard to race, color, religion creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Last Name
 

First Name
 

Middle Name
 

Street
 

City
 

State
 

Zip Code
 

Phone Number
 

Social Security Number
 

Position Applied For
 

How Did You Hear About Us
 

Driver's License Number
 

Driver's License Status (Florida? Safe Driver? Points Explain
 

E-Mail Address
 

Company
 

Comments

Are you currently employed?

 YES
 NO

May we contact your present employer?

 YES
 NO

Are  you available for work? When?

 YES
 NO

Do you need to give notice to present employer? How long?

 YES
 NO

Are you applying for full time?

 YES
 NO

Are you willing to work part time?

 YES
 NO

Are you willing to work temporary?

 YES
 NO

Can you work evenings when the job requires it?

 YES
 NO

Can you work weekends when the job requires it?

 YES
 NO

Can you travel if the job requires it?

 YES
 NO

If  you are under 18 years of age, can you provide required proof of your eligibility to work?

 YES
 NO

Have you ever filed an application with us before?

 YES
 NO

Do you have proof of citizenship?

 YES
 NO

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

 YES
 NO

Are you willing to submit to drug testing?

 YES
 NO

EDUCATION
 

NAME OF SCHOOL

COURSE OF STUDY

COMPLETED DEGREE

HIGH SCHOOL

 

 

 

UNDERGRADUATE COLLEGE

 

 

 

GRADUATE PROFESSIONAL

 

 

 

OTHER (SPECIFY)

 

 

 

Describe any specialized training and job-related skills

SPECIALIZED SKILLS

BICSI

 Yes

 No

What level?

 

Vender Certification

 Yes

 No

From Who?

 

Computers

 Yes

 No

Which Softwares?

 

PBX Systems

 Yes

 No

Which Brands?

 

Forein Language

 Yes

 No

Which One?

 

Special Tools

 Yes

 No

Which ones are you experienced with?
 
   

 

Which ones do you own?

 

PERSONAL REFERENCES

1 Name:

 

   Address

 

2 Name:

 

   Address

 

3 Name:

 

   Address

 

EMPLOYMENT EXPERIENCE

Employer
 

    

Address
 

Dates Employed

Work Performed
 

 

 

Phone
 

Hourly rate/salary
  Starting     Final

  

Job Title
 

Supervisor
 


 


 

  

Reason for leaving

 

Employer
 

    

Address
 

Dates Employed

Work Performed
 

 

 

Phone
 

Hourly rate/salary
  Starting     Final

  

Job Title
 

Supervisor
 

 

 

  

Reason for leaving

 

Employer
 

    

Address
 

Dates Employed

Work Performed
 

 

 

Phone
 

Hourly rate/salary
  Starting     Final

  

Job Title
 

Supervisor
 


 


 

  

Reason for leaving

 

Additional Information
 

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship will not be changed by any written documents or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

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


© 2006 Advanced Cable Connection Inc.
Phone: 813-978-0101     FAX:  813-972-3038