Application for Employment

Application for Employment
As an Equal Opportunity Employer, BCI does not discriminate on the basis of race, color, religion, sex, national origin, age disability, or veteran status. All information provided in this application will be treated confidentially and will be used only to help ensure the best use of your abilities if you are employed by us.
Name:
First Last
Date:
Date Format: MM slash DD slash YYYY
Email:
Phone:
Address:
City:
State:
Zip:
Social Security #:
Driver's License #:
Expiration Date:
Date Format: MM slash DD slash YYYY
Are you legally permitted to work for any employer in this country, without restriction?
- Yes
- No
Have you ever been convicted of a felony?
- Yes
- No
A positive response is not an automatic bar to employment with the company. The offense for which the person was convicted in relation to the position to which they have applied, will be considered.
If yes please explain:
On what date are you available for work?
Date Format: MM slash DD slash YYYY

Education:
(if not provided in as resume)
Select all that apply:
- High School
- College/University
- Post Graduate
- Business/Trade/Technical
- Other
High School - School and Degree
College/University - School and Degree
Post Graduate - School and Degree
Business/Trade/Technical - School and Degree
Other - School and Degree
Professional References:
Name Company & Title Telephone Email

Please list three

Employment History
Beginning with most recent
Employment History List
Company Business Type Supervisor Supervisor Title Supervisor Phone Position Held Employed From Employed To Ending Salary Reason for Leaving May we Contact?
Position you are applying for:
Salary you will require:

By signing my name below, I certify that the answers given in this application for employment are true and correct to the best of my knowledge. I understand that a drug test and background check will be required, and employment is contingent upon passing. I consent to this procedure should I be hired. I authorize investigation of all statements made in this application, as many as may be necessary in reaching an employment decision. I understand that any false or misleading information given in this application or during a pre-employment interview, including a failure to disclose requested information, shall be sufficient cause for dismissal. Employment at Bachelor Controls, Inc. is on an at will basis.
Applicant Signature:
Date:
Date Format: MM slash DD slash YYYY

Name	Company & Title	Telephone	Email

Company	Business Type	Supervisor	Supervisor Title	Supervisor Phone	Position Held	Employed From	Employed To	Ending Salary	Reason for Leaving	May we Contact?

Education: