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PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

QANTUM CAPE COD

154 Barnstable Road

Hyannis, MA 02601

(508) 778-2888 FAX (508)778-9651

 

APPLICATION FOR EMPLOYMENT

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

 

PLEASE COMPLETE PAGES 1-5.

DATE ________________________________

Name __________________________________________________________________________________________

                        Last                                                                 First                                                                Middle                                                             Maiden

Present address __________________________________________________________________________________

                                                                        Number                                                          Street                                      City                 State                Zip

How long ___________________

Social Security No. _______ –  _____  –  _________

Telephone (      )                                

If under 18, please list age ____________________


Position applied for  (1)_______________________

and salary desired   (2) ______________________

(Be specific)

Days/hours available to work

No Pref _______  Thur _________

Mon _________   Fri __________

Tue __________   Sat _________

Wed _________   Sun _________

How many hours can you work weekly? _______________________   Can you work nights? _______________________

Employment desired          qFULL-TIME ONLY              qPART-TIME ONLY              qFULL- OR PART-TIME

When available for work?______________

________________________________________________________________________________________________

 

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION
(Complete mailing address)

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

High School

 

 

 

 

 

 

 

 

 

College

 

 

 

 

 

 

 

 

 

Bus. or Trade School

 

 

 

 

 

 

 

 

 

Professional School

 

 

 

 

 

 

 

 

 

 

HAVE YOU EVER BEEN CONVICTED OF A CRIME? qNo                      qYes

If yes, explain number of  conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. _______________________________________________

________________________________________________________________________________________________

                   

 


PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

QANTUM CAPE COD

 

APPLICATION FOR EMPLOYMENT

 

DO YOU HAVE A DRIVER’S LICENSE?         qYes     qNo

What is your means of transportation to work? _______________________________________________________________________________________________

Driver’s license
number ___________________________  State of issue  _______        qOperator     qCommercial (CDL)     qChauffeur

Expiration date ______________________

Have you had any accidents during the past three years?

How many? ___________________________

Have you had any moving violations during the past three years?

How Many? ___________________________

 

OFFICE ONLY

 

 

                        qYes                                                                             qYes                     Word                      qYes

Typing            qNo                 _____ WPM                       10-key    qNo                      Processing            qNo           _____ WPM

Personal        qYes             PC          q                          

Computer      qNo              Mac        q                          

Other ______________________________________________

Skills ______________________________________________

 

Please list two references other than relatives or previous employers.

Name ______________________________________

Name ______________________________________________

Position _____________________________________

Position ______________________________________________

Company ___________________________________

Company ______________________________________________

Address _____________________________________

Address ______________________________________________

                _____________________________________

                ________________________________________

Telephone  (      )                                                                       

Telephone  (      )                                                                                                           

 

An application form sometimes makes it difficult for an individual to adequately summarize a complete background.  Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

 

 

 

 

 

 

 

 

 

 

 

             
 

 

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

QANTUM CAPE COD

 

APPLICATION FOR EMPLOYMENT

 

MILITARY

 

 

HAVE YOU EVER BEEN IN THE ARMED FORCES?                   qYes     qNo

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?                        qYes     qNo

Specialty _________________________________  Date Entered ________________  Discharge Date _________________________________________

 

Work Experience

Please list your work experience for the past five yearsbeginning with your most recent job held.
If you were self-employed, give firm name.  Attach additional sheets if necessary.

 

 

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

 

From

To

Start

Final

 

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

 

 

 

 

 

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

 

From

To

Start

Final

 

Your Last Job Title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

 

 

 

 

                   

 

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

QANTUM CAPE COD

 

APPLICATION FOR EMPLOYMENT

Work experience

Please list your work experience for the past five yearsbeginning with your most recent job held.
If you were self-employed, give firm name.  Attach additional sheets if necessary.

 

 

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

 

From

To

Start

Final

 

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

 

 

 

 

 

Name of employer
Address

Name of last supervisor

Employment dates

Pay or salary

City, State, Zip Code
Phone number

 

From

To

Start

Final

 

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

 

 

 

 

 

 

May we contact your present employer?        qYes     qNo

Did you complete this application yourself    qYes     qNo

If not, who did? _______________________________________________________________________________________________

               

 

 

PLEASE READ CAREFULLY

 

APPLICATION FORM WAIVER

 

In exchange for the consideration of my job application by Qantum Communications herinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Qantum Communications, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company.  Both the undersigned and Qantum may end the employment relationship at any time, without specified notice or reason.  If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application.  I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice.  I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy.  I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living.  Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

 

Signature of applicant__________________________________________ Date: ___________________

 

 

This Company is an equal employment opportunity employer.  We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability.  We assure you that your opportunity for employment with this Company depends solely on your qualifications.

 

                Thank you for completing this application form and for your interest in our business.

 

 

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE

Qantum Cape Cod

 

 

POST EMPLOYMENT INFORMATION FORM

TO BE COMPLETED AFTER EMPLOYEE HAS BEEN HIRED

Height ______ ft. ______ in.                            Weight __________                           Birth date _______________

Married  qYes     qNo      If married, how long? _____             qSingle    qSeparated     qDivorced     qWidowed

Full name of spouse _______________________________   Occupation ________________________________________________

Name of company _________________________________   Telephone  (      )_______________________________________________

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

Name  __________________________________________   Telephone  (      )_______________________________________________

Address _________________________________________   Relationship ________________________________________________

FOR INSURANCE PURPOSES ONLY: LIST ALL DEPENDENTS

 

NAME

RELATIONSHIP

BIRTH DATE

SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO BE COMPLETED

 

 

BY EMPLOYER

 

Date of employment  _________________   Job title ____________________   Dept. __________________________________

Location___________________________   Rate of pay _________________       qFull-time   qPart-time   qSalaried

Applicant’s signature acknowledging above information _______________________________________________________________________________________________

Drug test confirmation number ______________________________

Name of person verifying information _______________________________________________________________________________________________

Name of person authorizing employment _______________________________________________________________________________________________

               

 

 

Applicant Selection Criteria Record

 

JOB TITLE

 

CANDIDATES CONSIDERED (INCLUDING MINORITIES AND FEMALES)

 

NAME

MALE/

FEMALE

ETHNIC

CODE*

ON LAB SECTION/ OFF LAB

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     *ETHNIC CODES:  1-BLACK, 2-ORIENTAL, 3-HISPANIC, 4-AMERICAN INDIAN, 0-OTHER

CANDIDATE SELECTED

 

NAME

MALE/

FEMALE

ETHNIC

CODE

SOURCE

 

 

 

 

 

SELECTION CRITERIA

 

 

 

 

 

 

 

 

 

 

 

 

 

REASONS CANDIDATE SELECTED WAS PREFERABLE TO OTHERS

 

 

 

 

 

 

 

 

 

 

 

 

ORIGINATOR'S SIGNATURE

DATE

 

             

 

 

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