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Applicant Full Name*

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Home Address*

Street Address Address Line 2 City State ZIP Code

Number of years at this address*

Mobile Phone*

Other Phone

Date of Birth*

Email*

Job Position Applied For:*

Are you willing to work any shift, including nights and weekends?*

Yes

If no, please state any limitations:*

If applicable, are you available to work overtime?*

Yes

If you are offered employment, when would you be available to begin work?*

If hired, are you able to submit proof that you are legally eligible for employment in the United States?*

Yes

Are you able to perform the essential functions of the job position you seek without reasonable accommodation?*

Yes

What reasonable accommodation, if any, would you request?*

Have you ever been convicted of a felony or misdemeanor?*

Yes

If yes, please describe*

You need to include what you were convicted of, the date of conviction, and the city and state where you were convicted.

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

Education

Highest Level of Education Completed*

High School

Some College

College Degree

Advanced Degree

College/University Name and City/State

Did you receive a degree?

Yes

If yes, degree(s) received:

High School/GED Name and City/State

Did you graduate?

Yes

Other Training (graduate, technical, vocational):

Please indicate any current professional licenses or certifications that you hold:

Awards, Honors, Special Achievements:

Military Service:

Yes

Branch:

Specialized Training:

Employment Record

Include the employment history for at least a 3-year period preceding this application that includes the current employer.

Employers

References

Please list three non-relatives

References

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current or past employer:

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I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Quad Optical Services LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Supervisor, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Quad Optical Services LLC, except in a specific written contract of employment signed on behalf of the organization by its Supervisor, has the power to alter or vary the voluntary nature of the employment relationship. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

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