Employment Application | TECH, Hutchinson, KS

Name(Required)

First Last

Cell Phone

Home Phone

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about TECH?

Are you 18 years of age or older?(Required)

Yes

No

Do you currently have a valid driver's license?(Required)

Yes

No

Do you have a High School Diploma or GED?(Required)

Yes

No

If, no, would you be willing to take the KansasWorks WORKReady! series of testing?

Yes

No

Have you ever been convicted of a felony?(Required)

Yes

No

If you have been convicted of a felony, please explain.

Are you a citizen of the U.S. or an alien authorized to work in the United States?(Required)

Yes

No

Position Applying For

Date Available to Start(Required)

Shift Preference

FLSA Preference

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.(Required)

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

Supervisor

Address

Phone Number

Position

Start Date

End Date

Leave blank if you are currently employed

Reason for Leaving

May we contact this employer?

Employer 2

Name of company/organization

Supervisor

Address

Phone Number

Position

Start Date

End Date

Leave blank if you are currently employed

Reason for Leaving

May we contact this employer?

Employer 3

Name of company/organization

Supervisor

Address

Phone Number

Position

Start Date

End Date

Leave blank if you are currently employed

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(Required)

Phone Number(Required)

Occupation(Required)

Years acquainted(Required)

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?(Required)

Have you ever been asked to leave a job? If "yes", please explain.(Required)

Anything you'd like to tell us about your professional self?(Required)

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.?(Required)

Yes

No

What is the best way to contact you if TECH, Inc. is interested in scheduling an interview?(Required)

Cell Phone

Home Phone

Email Address

What is the best time to contact you if TECH, Inc. is interested in scheduling an interview?(Required)

Did anyone refer you to apply at TECH, Inc.?(Required)

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.(Required)

Yes

No

Do you agree to these terms?

Please type your First Name Middle Initial Last Name

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Education / Skills

Former Employers

Employer 1

Employer 2

Employer 3

References

Reference 1

Reference 2

Reference 3

Applicant Questionnaire