Employment Application

At Z-AXIS and Bear Power Supplies, we are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recognized basis including but not limited to race, age, color, religion, sex, marital status, national origin, ancestry, physical or mental disability, veteran status, or any other legally protected basis. US citizenship is required.

* Name

First

Last

* Current Address

Street Address

Address Line 2

City

State

ZIP Code

Permanent Address

Street Address

Address Line 2

City

State

ZIP Code

* Phone

* Email

Referred By:

Position you are applying for:

* Date you can start:

Salary desired:

* Are you currently employed?

Yes

* If yes: may we contact your current employer?

Yes

* Have you ever applied to work at this company before?

Yes

If yes, when and where?

* Are you willing to work overtime?

Yes

US Military Service:

Branch and Rank

If driving is a requirement of the job for which you are applying, do you have a current valid driver’s license?

Yes

If driving is a requirement of the job for which you are applying, continued employment is contingent on your maintaining a current driver’s license.

* Are you able, at the time of employment, to submit verification of your legal right to work in the U.S.?

Yes

Verification and completion of the I-9 form must be submitted no later than three business days after date of hire.

* Have you ever been convicted of a felony or a crime which is related to the functions or qualifications of the position for which you are applying?

Yes

A conviction record will not necessarily be a bar to employment.

If yes: please describe full the criminal conviction(s), listing the nature of the offense(s) and your rehabilitation since the conviction(s).

Education

High School

Name of School:

Location:

Years attended (Month/Year):

College

Name of School:

Location:

Major areas of study:

Years attended (Month/Year):

Trade, Business or Graduate School

Name of School:

Location:

Major areas of study:

Years attended (Month/Year):

Work Experience

List your last four employers, starting with your current or most recent place of employment. You may include any verified work performed on a volunteer basis.

Employment 1.

* Company Name:

* Dates Employed (Month/Year):

* Address:

* Name of Supervisor:

* Reason for Leaving

Employment 2.

* Company Name:

* Dates Employed (Month/Year):

* Address:

* Name of Supervisor:

* Reason for Leaving:

Employment 3.

* Company Name:

* Dates Employed (Month/Year):

* Address:

* Name of Supervisor:

* Reason for Leaving:

Employment 4.

* Company Name:

* Address:

* Dates Employed (Month/Year):

* Name of Supervisor:

* Reason for Leaving:

References

Please list three persons not related to you, whom you have known at least three years.

* 1. Name, Occupation, Address, Phone and Years Known

* 2. Name, Occupation, Address, Phone and Years Known

* 3. Name, Occupation, Address, Phone and Years Known

Upload Your Resume (Optional)

Max file size is 3 MB. Uploading resume to support your application is optional.

Applicant's Statement

I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission, or falsification be discovered, it will constitute grounds for dismissal. I hereby authorize you to conduct any investigation necessary concerning any part of my background related to the position I am seeking. I release all parties from any liability in connection with the prevision and use of such information. I understand and agree that, if employed by this organization; I will abide by its rules and regulations which I understand are subject to change. I further understand that, if hired, my employment is for no definite period of time and may be terminated by either party at any time.

* I agree to the Applicant's Statement.

Enter your initials here to confirm acknowledgement of statement.