Employment Application

Personal Information

Full Name

First

Middle

Last

Social Security Number

Email

Date of Birth

Phone

Address

Address Line 1

City

State / Province / Region

Postal Code

How long at address above?

Are You a US Citizen?

Yes
No

Emergency Contacts

Please provide two (2) emergency contacts

1. Name/Phone Number

2. Name/Phone Number

Please answer the following questions.

If related to anyone in our employ, state person's name and department.

Referred By

Have you ever entered a pleas of guilty to, been convicted of, or forfeited bond in relation to a felony or any dishonest act?

Yes
No

If yes, specify offense, date and court.

Do you have a valid driver’s license?

Yes
No

What is your means of transportation to work?

Driver's License Number

State of Issue

Expiration Date

Special License

Operator
Commercial (CDL)
Chauffeur

Have you had any accidents during the past three years?

Yes
No

If required, would applicant be able to carry 50lbs?

Yes
No

Have you had any moving violations during the past three years?

Yes
No

Activities Other Than Religious Civic, Athletic, Fraternal, etc.)

Please exclude: Organizations, the Name of Character of which indicates Race, Creed, Color or National Origin of its Members

U.S. Military or Present Membership In Naval Service

Please provide Rank

Present Membership In Naval Service Rank National Guard or Reserves

Employment Desired

Position

Date You Can Start

Desired Salary

Are You Employed Now?

Yes
No

If you are employed, may we inquire of your present employer?

Have you applied to this company before?

Yes
No

If yes, where and when?

Education

High School Name

College Name

Bus. or Trade School

Professional School

Years Attended

Date Graduated

Specific Studies

Subject Studied

Subjects of Special Study or Research Work

Employment History

Employment Dates

Employment Dates 2

Employment Dates 3

Employment Dates 4

Employer Name/Address

Employer Name/Address 2

Employer Name/Address 3

Employer Name/Address 4

Salary/Position

Salary/Position 2

Salary/Position 3

Salary/Position 4

Reason for Leaving

Reason for Leaving 2

Reason for Leaving 3

Reason for Leaving 4

Describe additional job related experiences, special skills, and training acquired which would be helpful in assessing your qualifications for employment consideration.

References

1-Name/Phone Number

2-Name/Phone Number

3-Name/Phone Number

Address

Occupation

Years Known

Attach Resume/CV

Click or drag a file to this area to upload.

Attach Cover Letter

Click or drag a file to this area to upload.

Consent and Agreement

MARYLAND LAW REQUIRES ALL APPLICANTS TO ACKNOWLEGE THE FOLLOWING:

"Under Maryland Law an employer may not require or demand, as a condition of employment , prospective employment, or continued employment, that an individual submit to or take a lie detector or similar test. an employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100."

I acknowledge I have read and understand the above statement:

Applicant's Signature

Clear Signature

Date of Application

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Tele-Plus Corporation (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the Company, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and the Company, may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that my driving record is required and reviewed. Information is shared with the company’s insurance company for insurance purposes. Violations affect your driving privileges and/or employment with the company.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of one hundred eighty (180) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Applicant's Signature

Clear Signature

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Date of Application

Do you agree to the terms and conditions of employment

Yes
No

Do you authorize a background check as part of the employment?

Yes
No

Please answer the following for security:

What is 7+9?

Providing Networking, Protection and Communication Solutions since 1977.

Application for Employment