Employment Application Application for Employment - Kansas FacilityWe are an "at-will," equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, age, sex, religion, disability, medical condition, national origin, marital status, or any other unlawful basis. All questions pertaining to any of these categories are collected solely for the purposes of EEO & AAP Reporting.Personal InformationName (Last, First, Middle)*Home Phone*Other PhoneEmail* Address* Street Address City State / Province / Region ZIP / Postal Code Date of Birth* Gender Male FemaleVeteran Yes NoHave you ever been employed or attended school under another name? If yes, please provide other name(s): Yes NoOther Names If hired, can you provide evidence of your identity and eligibility to work in this country? Yes NoIf hired, would you have a reliable means of transportation to and from work? Yes NoPosition InformationPosition Desired*Date Available to Begin Work* Salary Desired*Employment Desired* Full-Time Part-Time Special Project (Seasonal work or other) Part/Special Project Time AvailabilityHave you ever applied to this organization before? If yes, when? Yes NoPrior ApplicationCan your perform the essential functions of the position for which you are applying with or without reasonable accommodation? Yes NoWould you be available to work overtime if necessary? Yes NoEducation Name of School City and State Dates Level Completed Degree/Certification High SchoolName of SchoolCity and StateDatesLevel CompletedDegree/Certification CollegeName of SchoolCity and StateDatesLevel CompletedDegree/Diploma/Certification CollegeName of SchoolCity and StateDatesLevel CompletedDegree/Diploma/Certification Vocational TrainingName of SchoolCity and StateDatesLevel CompletedDegree/Diploma/Certification Describe below how your educational experiences relate to the position for which you are applying at US Tower.*SkillsPlease check any boxes corresponding to skills you possessTyping WPM Typing WPM WPM10 key by: 10 key by: Touch Sight Computer Computer Skills Name the specific software/equipment used Bilingual Bilingual What languages?Other Other Skills Switchboard Switchboard Name the specific software/equipment used Word Processing Word Processing Name the specific software/equipment used Spreadsheet Spreadsheet Name the specific software/equipment used Do you have any other experience, training, qualifications, accomplishments or skills which you feel make you especially suited for the position? If so, please explain.Former EmployersList below your employment history for the past 10 years, or your last three employers or period of unemployment, (whichever is greater) starting with the recent position.Former Employers InfoName and Address of EmployerTelephone NumberDates of Employment (From/To)Job TitleSalary HistoryName of Immediate SupervisorDescribe your Job DutiesReason for Leaving Have you ever been terminated from employment for a reason other than a layoff? Yes NoMay we contact your current employer? Yes NoIs there a criminal conviction (misdemeanor or felony) on your record? Yes NoDate of conviction If yes, please describe. Conviction does not automatically exclude you from consideration. US Tower will consider whether the offense is relevant to the position for which you have applied.ReferencesPlease list three professional references (exclude relatives) who have knowledge of your work performance.ListNamePhone NumberOccupationNumber of Years Acquainted PLEASE READ AND SIGN BELOW. Applications that have not been signed will be considered incomplete and will not be accepted. I certify that all information submitted on this application is true and complete. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any falsification, omission, or misrepresentation of material facts may constitute grounds for rejection of this application or immediate dismissal from employment, if hired, regardless of the time elapsed before discovery of the omission or misstatement. I authorize US Tower Corporation, and its representatives, to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment. I further authorize my former employers to disclose to US Tower Corporation any and all records and information regarding my work, and release the company, my former employers and all other persons or entities from any and all liability for issuing, receiving or using such information. I agree that if employed, I will abide by US Tower Corporation's policies and procedures. Upon termination, I authorize the release of reference information regarding my work while employed at US Tower Corporation and release all employees, agents and representatives form any and all claims I may have as a result of such disclosure. I understand that nothing contained in this application or conveyed during any interview, which may be granted, is intended to create a contract of employment. I understand that employment at US Tower Corporation is at-will, for no definite period and may be terminated at any time, with or without prior notice, with or without cause, at the option of either myself or the company. Agreements contrary to this policy may only be made in writing, signed by me and two of the company's directors. I understand that offers of employment may be contingent on the applicant's ability to pass a job-related examination and/or a skills and agility test. Applications are only accepted for a current available positions. Applications will be considered current for a period of 60 days. I accept the employer's right to enter into an Alternative Dispute Resolution Procedure to resolve employment disputes. This iframe contains the logic required to handle Ajax powered Gravity Forms.