Careers, Cont.

Name*
First Middle Last
Email*
Enter Email Confirm Email
Primary Telephone*
Secondary Telephone
Social Security Number*
Address*
Street Address Address Line 2 City State ZIP Code

Position applied for*
If you are under 18, and it is required, can you furnish a work permit?*
- Yes
- No
- I am 18 or older
If "No", please explain:
Have you ever been employed here before?*
- Yes
- No
If "Yes", give dates and positions:
Are you legally eligible for employment in this country?*
- Yes
- No
Date available to begin work*

What is your desired salary or hourly wage range?*
Type of employment desired*
Are you able to meet the attendance requirements of the position?*
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?*
If yes, please provide date(s) and details:
ANSWERING “YES” TO THIS QUESTION DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT, FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS, AND NATURE OF THE VIOLATION, REHABILITATION, AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.
Driver license number and state (if driving is an essential part of the job function)

Employment History
Provide the following information of your past three (3) employers, assignments, or volunteer activities, starting with the most recent.
Employer 1 of 3
Date Employment Began*
Date Employment Ended*
Employer Name*
Employer Address*
Street Address Address Line 2 City State ZIP Code
Employer Telephone*
Starting Job Title*
Final Job Title*
Immediate Supervisor and Title*
May we contact this employer for reference?*
Starting wage (per year or hourly)*
Final wage (per year or hourly)*
Summarize the nature of work performed and job responsibilities*
Reason for leaving*

Employer 2 of 3
If you have no prior employment, this page may be skipped by clicking "Next" below.
Would you like to enter information for a second past employer?*
Date Employment Began*
Date Employment Ended*
Employer Name*
Employer Address*
Street Address Address Line 2 City State ZIP Code
Employer Telephone*
Starting Job Title*
Final Job Title*
Immediate Supervisor and Title*
May we contact this employer for reference?*
Starting wage (per year or hourly)*
Final wage (per year or hourly)*
Summarize the nature of work performed and job responsibilities*
Reason for leaving*

Employer 3 of 3
If you have no prior employment, this page may be skipped by clicking "Next" below.
Would you like to enter information for a third past employer?*
Date Employment Began*
Date Employment Ended*
Employer Name*
Employer Address*
Street Address Address Line 2 City State ZIP Code
Employer Telephone*
Starting Job Title*
Final Job Title*
Immediate Supervisor and Title*
May we contact this employer for reference?*
Starting wage (per year or hourly)*
Final wage (per year or hourly)*
Summarize the nature of work performed and job responsibilities*
Reason for leaving*

Skills and Qualifications*
Summarize the training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Education Background
Summarize the training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Name and Location - High School
Number of years completed
High School Telephone
Course of study
Name and Location - College
Number of years completed
College Telephone
Course of study
Major
Degree
Name and Location - Other
Number of years completed
Other Telephone
Course of study

Professional References
References listed below must be professional working relationships - no personal, friends, or family references will be accepted.
Professional Reference #1
Telephone
Number of years known
Professional Reference #2
Telephone
Number of years known
Professional Reference #3
Telephone
Number of years known

Application Statement
I certify that all the information I have provided in order to apply for and secure work with the employer is true, complete, and correct.
I understand that any information provided by me which is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employer, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law.
I understand that EndevTec, at its sole discretion, may obtain a personal credit report from a Consumer reporting agency. This credit report may be a consideration in a decision on whether or not to hire applicant.
I understand that I may be required to submit to a drug test as a condition for employment and that the results of the drug test may affect my eligibility for employment with EndevTec.
I understand that this application remains current for only thirty (30) days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral, or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand, and accept all terms of the forgoing Applicant Statement.*
Enter your full legal name above to digitally sign this application.
Comments
This field is for validation purposes and should be left unchanged.

Careers, Cont.

Application for Employment

Step 1 of 9

Employment History

Employer 1 of 3

Employer 2 of 3

Employer 3 of 3

Education Background

Professional References

Application Statement

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