Electronics Technician Application

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How long have you lived at this address?*

Phone*

Email*

Date of Birth*

Are you currently authorized to work in the United States?*

Have you ever been convicted of a crime?*

If Yes, Please describe the circumstances of your conviction.

How many hours can you work on a weekly basis?*

What are your preferred work days?*

If hired, when are you available to start?*

What is the highest level of education you have achieved?*

Are you now or have you ever been a member of the Armed Forces?*

What are your most unique skills?*

Who was your most recent employer?*

Employer Address*

Street Address Address Line 2 City State ZIP Code

Name of Supervisor*

First Last

Supervisor or Business Phone*

How many years were you employed at this business?*

What was your ending wage?*

Reason for leaving (be specific)*

May we contact this employer for a reference?*

Date completed*