Application

Education / Skills
HIGH SCHOOL: Name & Location
HIGH SCHOOL: Number of Years Attended
HIGH SCHOOL: Certification Acquired
COLLEGE: Name & Location
COLLEGE: Number of Years Attended
COLLEGE: Certification Acquired
TRADE OR BUSINESS SCHOOL: Name & Location
TRADE OR BUSINESS SCHOOL: Number of Years Attended
TRADE OR BUSINESS SCHOOL: Certification Acquired
Do you have any military service experience that you feel would be relevant for the job you're applying for? Please Outline.*
Have you ever been employed by TECH before?
- Yes
- No
Dates
Title and Reason for Leaving

Former Employers
List below the last three employers you've had (if applicable) starting with the most recent.
Employer 1
Name of company/organization
Address
Phone Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY

Leave blank if you are currently employed
Supervisor
Position
Reason for Leaving
May we contact this employer?
Employer 2
Name of company/organization
Address
Phone Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY

Leave blank if you are currently employed
Supervisor
Position
Reason for Leaving
May we contact this employer?
Employer 3
Name of company/organization
Address
Phone Number
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY

Leave blank if you are currently employed
Supervisor
Position
Reason for Leaving
May we contact this employer?

References
Give the names of 3 people not related to you and whom you have known for at least 1 year.
Reference 1
Name*
Phone Number*
Occupation*
Years acquainted*
Reference 2
Name
Phone Number
Occupation
Years acquainted
Reference 3
Name
Phone Number
Occupation
Years acquainted

Applicant Questionnaire
Do you have any paid or unpaid experience working with people with disabilities?*
Have you ever been asked to leave a job? If "yes", please explain.*
Anything you'd like to tell us about your professional self?*

TECH, Inc. employees are required to attend paid training within hours that may not be consistent with the hours of the position. Would you be able to attend all required training for TECH, Inc.?*
- Yes
- No
What is the best way to contact you if TECH, Inc. is interested in scheduling an interview?*
- Cell Phone
- Home Phone
- Email Address
What is the best time to contact you if TECH, Inc. is interested in scheduling an interview?*
Did anyone refer you to apply at TECH, Inc.?*
If yes, who referred you?

Any job offers will be conditioned upon the applicant passing a drug screen. TECH, Inc. also has a policy of testing existing employees under various circumstances. Job offers may be also contingent upon satisfactory record checks, including but not limited to criminal background, DCF Abuse and Neglect Registries, and motor vehicle records. I hereby authorize my present and previous employers and listed references to release to TECH, Inc. any and all records of my service and other information concerning me; except that would indicate age, race, creed, color, sex, ancestry, or national origin. Further, I hereby release these parties from all damage except that resulting from misrepresentation which might result from furnishing the information. I hereby acknowledge that any employment relationship with TECH, Inc. is of an “at will” nature, which means that the employee may resign at any time and the employer may discharge the employee at any time with or without cause. It is further understood this “at will” employment relationship may not be changed by any written document or by conduct, for any period of time, unless such change is specifically acknowledged in writing and signed by the President/CEO. In the event of my employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of TECH, Inc. I agree to the Application Agreement and certify that the answers given herein are true and complete to the best of my knowledge.*
- Yes
- No
Do you agree to these terms?
Please type your First Name Middle Initial Last Name
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Step 1 of 7

Education / Skills

Former Employers

Employer 1

Employer 2

Employer 3

References

Reference 1

Reference 2

Reference 3

Applicant Questionnaire