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Maintco Employment Application Form
General
Name (First, Middle, Last)
Telephone Number
Email Address
Present Address - How long have you lived here (years)
Number & Street
City
State
Zip Code
Previous Address - How long have you lived there (years)
Number & Street
City
State
Zip Code
Were you ever employed by us?
Yes
No
If yes, please provide dates employed and positions held
Are you at least 18 years of age?
Yes
No
Job Interest
First Choice
Second Choice
Work Schedule Desired
Full Time
Part Time
Temporary
Date available to begin work
Wage or salary desired?
Are you willing to relocate?
Yes
No
Are you willing to travel?
Yes
No
Are you willing to work extra hours, weekends, and evenings?
Yes
No
Personal
Have you pled guilty, no contest, had a suspended imposition of sentence, or have been convicted of a misdemeanor or felony in the past 10 years, or are currently out on bail or own recognizance? (Convictions are not necessarily a reason for exclusion from consideration for employment)
Yes
No
If Yes, please describe each:
W-2 / W-4
The IRS requires employers to report employee wages, including the employee's name, address, and social security number. Employees will be required to complete a W-4. Failure and/or refusal to comply with this requirement may render an applicant / employee ineligible for employment and result in rescinding an offer of employment and/or discharge from employment
Have you ever used another name?
Yes
No
Are you capable of satisfactorily performing the essential functions required of the position for which you are applying?
Yes
No
Do you have adequate transportation to and from work?
Yes
No
Education
High School
Number of Years Completed
Graduated
College
Number of Years Completed
Graduated
University
Number of Years Completed
Graduated
Other
Number of Years Completed
Graduated
Scholastic Honors, Scholarships, Assistantships, Awards, Publications, etc...
Employment History
Company Name (Current or last employer)
Address
Dates Employed
Job Title
Wage/Salary
Reason for Leaving
Supervisor's Name
Supervisor's Title
Telephone
May We Contact?
Yes
No
Brief Description of Your Work and Responsibilities
Company Name (Current or last employer)
Address
Dates Employed
Job Title
Wage/Salary
Reason for Leaving
Supervisor's Name
Supervisor's Title
Telephone
May We Contact?
Yes
No
Brief Description of Your Work and Responsibilities
Company Name (Current or last employer)
Address
Dates Employed
Job Title
Wage/Salary
Reason for Leaving
Supervisor's Name
Supervisor's Title
Telephone
May We Contact?
Yes
No
Brief Description of Your Work and Responsibilities
Have you ever been terminated or asked to resign from any job?
Submit Resume
I certify that, to the best of my knowledge, the information given in this application and any attachments are true and correct. I understand that any incorrect, incomplete, false or misleading statement, answer or information will subject my application to disqualification from further consideration, or if employed, may subject me to termination of employment. I hereby agree that the Company may investigate my qualifications with previous employers, personal references and other background security or criminal conviction records. If employed, I agree to execute a confidentiality/assignment of invention agreement, in consideration of such employment. I understand my employment with the Company is terminable at-will and would not be for any fixed period of time, and I may resign at any time for any reason or the Company may terminate my employment at any time for any reason with or without notice, and that this application is not and is not intended to be a contract for continued employment. I understand that according to law all individuals who are hired must as a condition of employment produce certain documentation to verify their legal authorization to work in the US. As a consequence, I understand that offer of employment, (and continued employment) would be contingent on my ability to produce the required documentation within the time period required by law. I have read and understand all of the provisions of this statement and acknowledgement. By signing this application, I hold the Company harmless from any result of the reference check. I hereby authorize and release from liability all former employers, educational institutions, law enforcement agencies or other governmental agencies to provide or release information regarding my employment, education, criminal conviction record*, credit history*, driver's license and motor vehicle records that may be in their possession, to the Company or its agents. I further understand that an offer of employment (and continued employment) is conditioned upon several criteria, including my satisfactorily passing certain laboratory test (including test for substance abuse) which may be required by the Company. (* Please see the disclosure form provided by HR.)