Employment Application

Choose Location*

First Name*

Middle Initial

Last Name*

Email*

Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

If hired, can you provide evidence of legal eligibility to work in the U.S.?*

Yes
No

Any offer of employment is conditioned upon completing form I-9 and providing the appropriate documents for identity and work authorization.

Position Desired

Wage/Salary Desired

Interested in Working*

Full Time
Part Time

Have you ever been convicted of a felony, or a misdemeanor involving any violent act, use or possession of a weapon, or act of dishonesty for which the record has not been sealed or expunged, or do you have such a case pending?*

Yes
No

If yes, when & where?

Date you can begin work

Are you 18 years of age or older?*

Yes
No

If under 18, you will be required to submit a birth certificate or work certificate as required by federal law.

Name of high school attended*

City/State*

Degree Received*

Graduate
GED

Name of college attended*

City/State*

Graduate?*

Yes
No

Degree*

Yes
No

Major

Are you presently enrolled in school?*

Yes
No

If yes, give name & address of school

If yes, give expected degree date

List any job-related skills or accomplishments, including military service

Give Three References Who We May Contact

Name & Occupation*

How do you know them, and for how long?*

Phone*

Name & Occupation*

How do you know them, and for how long?*

Phone*

Name & Occupation*

How do you know them, and for how long?*

Phone*

Your Employment History

List name of employers with present or last employer listed first. Please note if we may not contact your present employer until after you are offered a position.

Name of Employer

Job Title

Supervisors Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Duties

Date of Employment

From

To

Type of Pay

Hourly
Salary

Ending Pay

Starting Pay

Reason for Leaving

Name of Employer

Job Title

Supervisors Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Duties

Date of Employment

From

To

Type of Pay

Hourly
Salary

Ending Pay

Starting Pay

Reason for Leaving

Name of Employer

Job Title

Supervisors Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Duties

Date of Employment

From

To

Type of Pay

Hourly
Salary

Ending Pay

Starting Pay

Reason for Leaving

CAREFULLY READ EACH STATEMENT BEFORE SIGNING AT THE BOTTOM

I certify that all of the information provided in this employment application are true and complete to the best of my knowledge, and I authorize investigation of all statements contained in this application, including a criminal background and credit history check. I understand that any false or incomplete information may disqualify me from further consideration for employment and may result in my immediate discharge if discovered at a later date. I understand and acknowledge that unless otherwise defined by applicable law or written agreement with ZERO CONNECT any employment relationship with the Company is considered “employment at will.” This means the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause, and with or without advance notice. I authorize the investigation of any or all statements contained in this application and also authorize any person, school, current employer, past employers, and other organizations to provide information concerning my previous employment and other relevant information that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I have read, understand, and agree to the above statements*

Yes

Signature*

Date

Name

This field is for validation purposes and should be left unchanged.