Employment Application – Mitchan Cellular
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We are an equal opportunity employer and do not unlawfully discrimination in employment. Employers
are required to provide equal employment opportunity and may ask your national origin, race and sex
for planning and reporting purposes only. This information is optional and failure to provide it will have
no affect on your application for employment.
As a part of the application process, prospective employees will be required to satisfactorily pass a
drug and alcohol test. Any offer of employment is conditioned on all test results being negative. A
confirmed positive drug or alcohol test will render an applicant ineligible for employment.
Interviews are given on a competitive basis using job related factors, after a written application has
been received and reviewed. The submission of an application does not guarantee an interview.
Applicant Data Position applying for:
How were you referred to us?
Date of interview (month/day/year)
/ /
Full Name:
Address: City: State: Zip:
Phone: Mobile/Pager/Other: E-mail:
Date Available to Start: / / Social Security number: - -
If you are under 18 years of age, can you provide a work permit? Yes No If no, please explain:
Have you ever worked for this company before? Yes No If yes, please explain:
Are you a citizen of the United States? Yes No If not, are you legally allowed to work in the United States? Yes No
Type of employment desired: Full-time Part-time Temporary Seasonal Salary Desired:
Have you ever pleaded guilty, no contest or been convicted of a crime? Yes No If yes, give dates and details:
Answering yes to this question does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and
position applied for will be considered.
Fluent in English: Fluent in Spanish:
Driver’s license number (if applicable to position): State:
11111
Summarize Your Special Skills or Qualifications
EDUCATION: Yrs. Completed Field of Study Graduate or Degree
_________________________________________________________________________________________________________________________
High School
_________________________________________________________________________________________________________________________
College/University
_________________________________________________________________________________________________________________________
Business/Technical
_________________________________________________________________________________________________________________________
Other (May include grammar school)
Previous Employment (begin with most recent position)
Date of employment: From____/____/____ To____/____/____ Position(s) Held: ________________________________________
Company Name: Address:
City: State: Zip: Phone:
Supervisor: Title:
Responsibilities:
Starting Salary and Title: Ending Salary and Title:
Reason for Leaving:
May we contact this employer for a reference? Yes No
Date of employment: From____/____/____ To____/____/____ Position(s) Held: ________________________________________
Company Name: Address:
City: State: Zip: Phone:
Supervisor: Title:
Responsibilities:
Starting Salary and Title: Ending Salary and Title:
Reason for Leaving:
May we contact this employer for a reference? Yes No
Date of employment: From____/____/____ To____/____/____ Position(s) Held: ________________________________________
Company Name: Address:
City: State: Zip: Phone:
Supervisor: Title:
Responsibilities:
Starting Salary and Title: Ending Salary and Title:
Reason for Leaving:
May we contact this employer for a reference? Yes No
I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal,
employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools
and individuals from all liability when responding to inquiries in connection with my application.
In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.
Signature of Applicant: _______________________________________________________ Date:
