Start your career in Telecom with BACO BAZON-COX & ASSOCIATES, INC Employment Application APPLICANT INFORMATION Last Name First M.I. Date Street Address Apartment/Unit # City State ZIP Email Address Phone Place of Birth Position Applied for & Desired Salary Are you a citizen of the United States? YesNo If no, are you authorized to work in the U.S.? YesNo Have you ever worked for this company? YesNo If so, when? Have you ever been convicted of a felony? YesNo If yes, explain Are you applying for: Temporary work - such as summer or holiday work? YesNo Regular part-time work? YesNo Regular full-time work? YesNo If hired, would you have transportation to and from various work locations? YesNo Can you work evenings? YesNo Are you available to work overtime? YesNo What day and hours are you available for work? If applying for temporary work, when will you be available? If hired, on what date can you start working? Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? YesNo Do you have a current drivers license? YesNo Do you have an active security clearance? YesNo Are you willing to travel? YesNo Do you have experience in telecom, security, or commercial electrical? EDUCATION High School Address From to Did you graduate? YesNo Degree College Address From to Did you graduate? YesNo Degree Other Address From to Did you graduate? YesNo Degree REFERENCES Please list three professional references. Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address PREVIOUS EMPLOYMENT Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YesNo Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YesNo Company Phone Address Supervisor Job Title Starting Salary Ending Salary Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YesNo MILITARY SERVICE Branch From To Rank at Discharge Type of Discharge If other than honorable, please explain Please check if you have any of the following credentials FBI Striped or Green YesNo SCI YesNo Top Secret YesNo Secret YesNo DCJS YesNo TWIC YesNo DBID YesNo CoVB Badge YesNo VCU Badge YesNo PLEASE READ, INITIAL, SIGN AND DATE BELOW I certify that my answers are true and complete to the best of my knowledge If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such examination or revelation. To acknowledge and sign please print your full name and date. Name Date Upload a resume in PDF format Cover Letter (Optional) Δ
