CI3 Integrators

Employment Application

*First Name: *Middle Name:

*Last Name:

*Address:

*City: *State: *Zip Code:

*Home Phone: Cell Phone:

*Email:

*Position Applying For:

Salary Desired: Start Date (mm/dd/yy):

Instructions: Please either completely fill out this online application or you may just fill out the required fields and upload your cover letter and resume at the bottom of this form.

Note: All applicants must pass a drug screening and criminal history check before beginning employment with CI3.

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.

* = required field

Education

Type of School

Name of School and Complete Mailing Address

Years Completed

Major or Degree

High School:

College:

Trade School:

Professional School:

Other:

Background

*Have you ever been convicted of a felony?

If yes, please explain:

Do you have a drivers license?

State of Issue:

Have you had any accidents in the past 3 years?

If so, how many?

Have you had any moving violations in the past 3 years?

If so, how many?

Previous Employment (List up to three)

Company Name:

Name of Supervisor:

Address:

Phone #:

May we contact your employer?

Job Title:

Reason for Leaving:

Start Date (mm/dd/yy):

End Date (mm/dd/yy):

Salary:

List the duties performed, skills used or learned, or advancements while you worked for this company (15 lines of text limit):

Company Name:

Name of Supervisor:

Address:

Phone #:

May we contact your employer?

Job Title:

Reason for Leaving:

Start Date (mm/dd/yy):

End Date (mm/dd/yy):

Salary:

List the duties performed, skills used or learned, or advancements while you worked for this company (15 lines of text limit):

Company Name:

Name of Supervisor:

Address:

Phone #:

May we contact your employer?

Job Title:

Reason for Leaving:

Start Date (mm/dd/yy):

End Date (mm/dd/yy):

Salary:

List the duties performed, skills used or learned, or advancements while you worked for this company (15 lines of text limit):

Please list two references other than relatives and previous employers

Name:

Position:

Company:

Phone #:

Please add any additional comments you feel we should know

Your Cover Letter & Resume

You may upload your cover letter and resume as either a Microsoft Word or an Adobe PDF document.

Upload your cover letter:

Upload your resume:

Employment Agreement

"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 rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, at any time, at either my or the company's option. I understand that no company representative, other than its 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."

* I agree to the above statement