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test brian_7ml61490 2019-07-31T06:50:57+00:00

PERSONAL INFORMATION

FULL NAME*
First Middle Last
DATE*
MM
DD
YYYY
E-MAIL
PHONE NUMBER*
ADDRESS*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
IN CASE OF EMERGENCY NOTIFY:
First Address Phone
POSITION DESIRED
START DATE*
SALARY DESIRED
EDUCATION, TRAINING, AND EXPERIENCE

EDUCATION
GRAMMAR SCHOOL
NAME AND LOCATION OF SCHOOL
*NO. OF YEARS ATTENDED
*DID YOU GRADUATE?
SUBJECTS STUDIED
HIGH SCHOOL
NAME AND LOCATION OF SCHOOL
*NO. OF YEARS ATTENDED
*DID YOU GRADUATE?
SUBJECTS STUDIED
COLLEGE
NAME AND LOCATION OF SCHOOL
*NO. OF YEARS ATTENDED
*DID YOU GRADUATE?
SUBJECTS STUDIED
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL
NAME AND LOCATION OF SCHOOL
*NO. OF YEARS ATTENDED
*DID YOU GRADUATE?
SUBJECTS STUDIED

GENERAL

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK:	SPECIAL SKILLS:	ACTIVITIES: (CIVIC, ATHLETIC, ETC.)EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.

Check Box Radio Buttons Text Area Text Box Number Time
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two
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one
two
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:HH
:MM
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Country
State
City
Street
Postal code
U.S. MILITARY OR NAVAL SERVICE
RANK
PRESENT MEMBERSHIP IN NATIONAL GUARD RESERVES
FORMER EMPLOYERS: LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH THE MOST RECENT.
START DATE END DATE NAME/ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING?
WHICH OF THESE JOBS DID YOU LIKE BEST AND WHY?
REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN FOR AT LEAST ONE YEAR.*
NAME ADDRESS BUSINESS YEARS AQUAINTED
HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE?*
- Yes
- No
IF SO, WHEN?
IF SO, WHERE?
REFERRED BY?
ARE YOU CURRENTLY EMPLOYED?*
- Yes
- No
IF SO, CAN WE CONTACT YOUR EMPLOYER?
- Yes
- No
DO YOU HAVE ANY MENTAL OR PHYSICAL DISABILITIES THAT WOULD KEEP YOU FROM PERFORMING THE FUNCTIONS OF THIS JOB WITH OR WITHOUT REASONABLE ACCOMMODATION?*
- Yes
- No
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF A VISA OR IMMIGRATION STATUS?*
- Yes
- No
HAVE YOU EVER BEEN CONVICTED OF A CRIME?*
- Yes
- No
IF YES, PLEASE EXPLAIN
PRECISION OPTICAL GROUP, INC. REQUIRES RANDOM DRUG & ALCOHOL TESTING.
* THIS FORM HAS BEEN REVISED TO COMPLY WITH THE PROVISIONS OF THE AMERICANS WITH DISABILITIES ACT AND THE FINAL REGULATIONS AND INTERPRETIVE GUIDANCE PROMULGATED BY THE EEOC ON JULY 26,1991. THIS FORM HAS BEEN DESIGNED TO STRICTLY COMPLY WITH STATE AND FEDERAL FAIR EMPLOYMENT PRACTICE LAWS PROHIBITING EMPLOYMENT DISCRIMINATION.
"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATE, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING."*
- AGREE TO PRECISION OPTICAL GROUP, INC. TERMS
Date

Day
Month
Year
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