Employment Application Form

Last name

Middle Name

First Name

Previous name(s)

Permanent address

How long at current address?

E-Mail

Address 2

Primary Phone Number

Alternate Phone Number

City

Desired Salary range

How were you referred?

State

Zip:

Position desired

Date available for work

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming

Cable Installation Technicians Dispatchers Drop Plow Operators Field Managers Prewire/Postwire Installation Tech Quality & Safety Assurance Tech Other

Type of employment desired

Are you available to work evenings?

Are you willing to travel?

Are you willing to relocate?

Full Time

Part Time

Yes

No

Yes

No

Yes

No

Temporary

Seasonal

Are you at least 18 years of age?

Are you available to work weekends?

Do you have a legal right to work in the United States?

Are you able to meet the attendance requirements of this position?

Yes

No

Yes

No

Yes

No

Yes

No

Have you ever plead 'guilty' or 'no contest' or been convicted of a crime?

If 'Yes' please provide details including date(s) city, state and charge.

Have you ever worked for Broadband Express or its affiliates?

If 'Yes' give dates, location and position.

Yes

No

Yes

No

Previous address

Previous address

Previous address

Street

City, State, Zip

Dates

From

To

From

To

From

To

Present or last employer

Previous employer

Previous employer

Name of Employer

City, State of employer

Job title, duties

Supervisors name

Supervisors phone

From

To

From

To

From

To

Salary

From

To

From

To

From

To

Dates of employment

Reason for leaving

Name

Phone Number

Association

No. of years known

1.

2.

3.

School name & location
(city, state and country if not in US)

Major course of study

Check last year completed

Degree/Certificate

High School/Ged

College/Trade School

Graduate School

Skills:

Professional Certificates/Affiliations:

Attach your resume:

You may attach a copy of your resume in Word, or plain text format here. Type the path and file name in the field or select the browse button to locate your file.

Nature of Employment: If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

Certification of Accuracy Statement: I certify that all information that I have provided on this application, related papers and in interviews is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of the application, (ii) rescind an employment offer, (iii) immediately discharge me from Broadband Express, LLC or its affiliates service, whenever it is discovered. I expressly authorize, without reservation, the employer and/or its representatives, including employees, agents and consumer reporting bureaus, to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in the application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agent, employees or representatives, for seeking, gathering and using such information in the employment process and other person, corporations or organizations for furnishing such information about me.

I understand that Broadband Express, LLC and its affiliates do not discriminate against any employee or applicant for employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. I understand that is the policy of Broadband Express, LLC and its affiliates to provide equal employment opportunity to all qualified applicants and employees, without regard to race, color, national origin, religion, gender, age, disability, veteran status or any other characteristic otherwise protected by law.

I understand that this application will remain current for 30 days; after that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to complete a new application.

I also understand that if I am hired, I will be required to provide proof or identity and legal authority to work in the United States and that federal employment laws require me to complete an I-9 form.

By selecting the Submit button below, I certify that I have read, fully understand and accept all terms of the forgoing Applicant Release and Privacy Statement.