BH Electronics, Inc. Application for Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation or any other legally protected status.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER

1BH Electronics, Inc. Application

2BH Electronics, Inc. Job Description

3Voluntary Self-identification of Disability

4VEVRAA Self ID

5Equal Employment Opportunity Voluntary Data Sheet

Position (s) applied for *
Date Date * / MM / DD YYYY
How did you learn about us? *

How did you learn about us? Advertisement Employment Agency Friend Relative Walk-in Other Other
Name Name * First Middle Last
Phone Phone * - ### - ### ####
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
If you are UNDER 18 years of age, can you provide required proof of your eligibility to work? *

If you are UNDER 18 years of age, can you provide required proof of your eligibility to work? Yes No Not applicable
Have you ever filed an application with us before? *

Have you ever filed an application with us before? Yes No If yes, give date If yes, give date
Have you ever been employed with us? *

Have you ever been employed with us? Yes No If yes, give date If yes, give date
Are you currently employed? *

Are you currently employed? Yes No
May we contact your present employer? *

May we contact your present employer? Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment. *

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment. Yes No
On what date would you be available for work? On what date would you be available for work? * / MM / DD YYYY
Are you available to work *

Are you available to work Full Time Part Time Summer
Are you currently on 'lay-off status and subject to recall? *

Are you currently on 'lay-off status and subject to recall? Yes No
Can you travel if a job requires it? *

Can you travel if a job requires it? Yes No
EDUCATION
High School Name and Address *
High School Courses of Study *
High School Years Completed *
High School Diploma? *

High School Diploma? Yes No GED
Undergraduate College Name and Address
Undergraduate Courses of Study
Undergraduate Years Completed
Undergraduate College Diploma?

Undergraduate College Diploma? Yes No
Indicate a foreign language you can speak, read and/or write
Speak

Speak Fluent Good Fair
Read

Read Fluent Good Fair
Write

Write Fluent Good Fair
Indicate another foreign language you can speak, read and/or write
Speak

Speak Fluent Good Fair
Read

Read Fluent Good Fair
Write

Write Fluent Good Fair
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any job-related training received in the United States Military
ADDITIONAL INFORMATION
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experiences.
Specialized Skills:
Skills / Equipment Operated

Specialized Skills:
Skills / Equipment Operated PC Calculator Typewriter Fax Excel Word
Production or Mobile Machinery Operated
Other (please list)
Share any additional information you feel may be helpful to us in considering your application.
NOTE TO APPLICANTS: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

ARE YOU CAPABLE OF PERFORMING IN A REASONABLE MANNER, WITH OR WITHOUT A REASONABLE ACCOMMODATION, THE ACTIVITIES INVOLVED IN THE JOB OR OCCUPATION FOR WHICH YOU HAVE APPLIED? A DESCRIPTION OF THE ACTIVITIES INVOLVED IN SUCH A JOB OR OCCUPATION IS INCLUDED WITH THIS APPLICATION.

NOTE TO APPLICANTS: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

ARE YOU CAPABLE OF PERFORMING IN A REASONABLE MANNER, WITH OR WITHOUT A REASONABLE ACCOMMODATION, THE ACTIVITIES INVOLVED IN THE JOB OR OCCUPATION FOR WHICH YOU HAVE APPLIED? A DESCRIPTION OF THE ACTIVITIES INVOLVED IN SUCH A JOB OR OCCUPATION IS INCLUDED WITH THIS APPLICATION. Yes No
1. Reference Name 1. Reference Name * First Middle Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
2. Reference Name 2. Reference Name * First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
3. Reference Name 3. Reference Name * First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
EMPLOYMENT EXPERIENCE

PLEASE PROVIDE 10 YEARS OF EMPLOYMENT HISTORY IF YOU

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicated race, color, religion, gender, national origin, disabilities or other protected status.
1. Employer *
Job Title *
Phone Phone * - ### - ### ####
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Supervisor *
Reason for Leaving *
Employed From Employed From * / MM / DD YYYY
Employed To Employed To * / MM / DD YYYY
Starting Wage / Salary * $ Dollars . Cents
Final Wage / Salary * $ Dollars . Cents
Work performed *
2. Employer
Job Title
Phone Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Supervisor
Reason for Leaving
Employed From Employed From / MM / DD YYYY
Employed To Employed To / MM / DD YYYY
Starting Wage / Salary $ Dollars . Cents
Final Wage / Salary $ Dollars . Cents
Work performed
3. Employer
Job Title
Phone Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Supervisor
Reason for Leaving
Employed From Employed From / MM / DD YYYY
Employed To Employed To / MM / DD YYYY
Starting Wage / Salary $ Dollars . Cents
Final Wage / Salary $ Dollars . Cents
Work performed
4. Employer
Job Title
Phone Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Supervisor
Reason for Leaving
Employed From Employed From / MM / DD YYYY
Employed To Employed To / MM / DD YYYY
Starting Wage / Salary $ Dollars . Cents
Final Wage / Salary $ Dollars . Cents
Work performed
List professional, trade, business or civic activities and offices held.
(You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.)
APPLICANT'S STATEMENT
I certify that answers given herein are true and accurate to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 30 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand that I must have the minimum qualification for an identified open position and have filled out this application completely and signed it to be considered. Employment may be contingent on successful completion of a medical examination.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an 'at will' nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this 'at will' employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

I release BH Electronics, Inc. from liability for performing reference checking and releasing information to subsequent employers. I authorize the release of information for reference checking from all former employers.

In the event of 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 the employer.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY

BH Electronics, Inc. Application for Employment

BH Electronics, Inc. Application for Employment

EDUCATION

ADDITIONAL INFORMATION