APPLICATION FOR EMPLOYMENT

In absence of a French translation, this form can be completed in French language for French speakers.

PERSONAL INFORMATION Date of application:

Name:
Last First Middle

Address:
Include City and Region

Alternate Address (optional):

Include City and Region

Contact Information:
Home Telephone Mobile

Email address:

How did you learn about this opportunity?

Position Applying for: Desired Salary: Available Start Date: Are you currently employed? YES NO

If YES, provide details about your current employer including job description

How many hours can you work weekly? Employment desired Computer Skills Do you have any specific computer training? If YES, provide details: Typing speed Do you have a computer at home? YES Part time only

Can you work nights? YES NO Full time Only Part or full time

YES

NO

NO

Have you ever been convicted for a crime? YES NO If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

EDUCATION

Name of School

Degree/Diploma

Graduation Date

Specialized training

Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position.

EMPLOYMENT HISTORY
(List last five employers. Please list beginning from most recent) Dates Employed Company name and contact details Location Role/Title

Job notes, tasks performed and reason for leaving:

Dates Employed

Company name and contact details

Location

Role/Title

Job notes, tasks performed and reason for leaving:

Dates Employed

Company name and contact details

Location

Role/Title

Job notes, tasks performed and reason for leaving:

Dates Employed

Company name and contact details

Location

Role/Title

Job notes, tasks performed and reason for leaving:

Dates Employed

Company name and contact details

Location

Role/Title

Job notes, tasks performed and reason for leaving:

May we contact your last employer? YES NO

References (Provide two references, do not list relatives) Name/Tle Position Company Address Telephone Name/Tle Position Company Address Telephone

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Did you complete this application yourself YES NO If not, who did? I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Name

Date

Signature

This is equal employment opportunity. Human Resource email: HR@unicomnetwork.net