Job Application

Your Personal Information

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Your Name(Required)

First Middle Last

Date of Birth(Required)

SSN(Required)

Current Address(Required)

Street Address City State ZIP Code

Previous Address

Street Address City State ZIP Code

Phone(Required)

Email Address(Required)

Specify other name(s) used during employment or education:

Specific Position for Which I Am Applying

Date Available to Begin Work:(Required)

Hiring Salary Expectation:

Desired Schedule:

Hours/Days Available:

Referral Source:

Employee Name

How Did You Find Us?

Upon employment, can you furnish proof of your legal right to work in the United States?(Required)

Yes

If you are under 18 years of age, can you provide required proof of your eligibility to work?(Required)

Yes

N/A

Have you been convicted of a felony?(Required)

Conviction will not necessarily disqualify an applicant for employment, but a false response will.

Yes

If yes, please explain:

Where driving is one of the requirements for this position, do you have a valid driver’s license?

Yes

Have you ever been convicted of driving while intoxicated (DWI)?(Required)

Conviction will not necessarily disqualify an applicant for employment, but a false response will.

Yes

If yes, please explain:

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I certify all information provided on this application and accompanying documentation is correct and complete to the best of my knowledge, and I have not knowingly withheld any fact or information. I understand any misrepresentation or falsification of information or material omission may be cause for disqualification from further consideration of employment, withdrawal of an employment offer, or if employed, may be cause for disciplinary action up to and including dismissal.

I understand that as part of my application for employment, BCS Switchgear, Inc. (the “Company”) will conduct a drug screening and thorough investigation of my background, including any criminal history and my driving record. Separate documents containing certain legally required disclosures and my written authorization to conduct such background checks will be provided to me in advance of any background check. I understand that any offer of employment is contingent on the satisfactory completion of the background investigation and drug screening. I release the Company from any and all liability that might result from making such investigation and screening and acknowledge that the findings of such investigation and screening may be cause for disqualification from further consideration of employment, withdrawal of an employment offer, or if employed, may be cause for disciplinary action up to and including dismissal.

If employed by the Company, I agree to comply with and be bound by all company policies, practices, and safety guidelines; I will report all suspected violations related thereto and will conduct the Company’s business in a strictly ethical, professional, and legal manner. I understand and agree that all programs, benefits, policies and practices of the Company may be subject to exceptions or change at any time, with or without notice, as determined by the Company.

I understand employment with the Company is not a contract, expressed or implied, and is not guaranteed for any term. Employment is “at will,” meaning either party may terminate the relationship at any time for any reason, with or without cause or notice. I understand no management official is authorized to make any oral assurance or promise of continued employment, or to make any agreement contrary to the foregoing.

I affirm that I am able to perform the essential functions of the job for which I am applying and will request reasonable accommodation as needed, if necessary.

Full Name(Required)

Date(Required)

EQUAL EMPLOYMENT OPPORTUNITY DATA

BCS Switchgear, Inc. provides equal opportunity to all qualified individuals, without regard to race, color, religion, age, sex, national origin, marital status, veteran status, disability, or other legally protected status, in conformity with all federal and state laws.

Employers collect data to provide periodic reports to the United States government regarding the sex, ethnicity, disability, or other protected status of employees and applicants. In order for BCS Switchgear, Inc. to comply with government record keeping, reporting, and other legal requirements, we ask you to voluntarily provide the information requested below. Please be aware you are not obligated to complete this form, and that any information you do provide voluntarily will be treated strictly confidential and kept separate from the Application for Employment. Inclusion or exclusion of requested information will have no effect on further employment consideration or hiring decisions.

Employment data checkbox

I elect to voluntarily provide the information requested below.

I decline to provide the information requested below.

Check One

Male

Female

Check One

AFRICAN AMERICAN/BLACK

HISPANIC

ASIAN/PACIFIC ISLANDER

CAUCASIAN

NATIVE AMERICAN

Other

CHECK IF ANY OF THE FOLLOWING ARE APPLICABLE:

VIETNAM VETERAN

DISABLED INDIVIDUAL

DISABLED VETERAN

EDUCATION

High School

School Name

Location

Years Completed

Diploma/Degree/ Certificate Received

Courses of Study

Cumulative Grade Point Average (GPA)

Undergraduate College/University

School Name

Location

Years Completed

Diploma/Degree/ Certificate Received

Courses of Study

Cumulative Grade Point Average (GPA)

Graduate/Professional

School Name

Location

Years Completed

Diploma/Degree/ Certificate Received

Courses of Study

Cumulative Grade Point Average (GPA)

Other

School Name

Location

Years Completed

Diploma/Degree/ Certificate Received

Courses of Study

Cumulative Grade Point Average (GPA)

Academic Honors Received:

Professional Designations and Licenses:

(Please include effective dates, if applicable.)

Designation

Date Effective

Specialized Job-related Training, Skills or Knowledge (including computer software):

Foreign Language(s):

Please list any foreign language(s) you speak, read, and/or write. (Information will be used only for job-related purposes.

Language

Speak

Read

Write

MILITARY EXPERIENCE

Branch of Service

Start Date

End Date

Describe any job-related training received in the military:

EMPLOYMENT EXPERIENCE

Employer:

Phone

Address

Street Address City State ZIP Code

Title

Start Date

End Date

Manager's Name

Manager's Title

Starting Salary/Hourly Rate

Ending Salary/Hourly Rate

Bonuses

May we contact your current employer?

Yes

Reason for Leaving:

Job Responsibilities:

Employer:

Phone

Address

Street Address City State ZIP Code

Title

Start Date

End Date

Manager's Name

Manager's Title

Starting Salary/Hourly Rate

Ending Salary/Hourly Rate

Bonuses

Reason for Leaving:

Job Responsibilities:

Employer:

Phone

Address

Street Address City State ZIP Code

Title

Start Date

End Date

Manager's Name

Manager's Title

Starting Salary/Hourly Rate

Ending Salary/Hourly Rate

Bonuses

Reason for Leaving:

Job Responsibilities:

Employer:

Phone

Address

Street Address City State ZIP Code

Title

Start Date

End Date

Manager's Name

Manager's Title

Starting Salary/Hourly Rate

Ending Salary/Hourly Rate

Bonuses

Reason for Leaving:

Job Responsibilities:

Employer:

Phone

Address

Street Address City State ZIP Code

Title

Start Date

End Date

Manager's Name

Manager's Title

Starting Salary/Hourly Rate

Ending Salary/Hourly Rate

Bonuses

Reason for Leaving:

Job Responsibilities:

OTHER RELEVANT SKILLS OR EXPERIENCE

List other skills/experience that doesn't fit above

* IMPORTANT: After submitting the application, please wait for Submission Confirmation before closing your browser.

Your Personal Information

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EQUAL EMPLOYMENT OPPORTUNITY DATA

EDUCATION

MILITARY EXPERIENCE

EMPLOYMENT EXPERIENCE

OTHER RELEVANT SKILLS OR EXPERIENCE

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