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COMPETITIVE COMPENSATION
MEDICAL, DENTAL AND VISION
LIFE AND DISABILITY INSURANCE
EMPLOYER MATCH 401(K) RETIREMENT PLAN
ON-THE-JOB TRAINING - HOLIDAY PAY - PAID TIME OFF
EMPLOYMENT APPLICATION
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Position Applied for
Please Select Position
Technician
Shipping
Admin
Other
Desired Salary
Name
*
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Home Phone
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Email
*
Where you previously employed with us?
Yes
No
If Yes - When?
If your application is considered favorably, what date will you be available for work?
If hired, can you provide proof that you are over 18 years of age?
Yes
No
Are you seeking full-time, part-time, temporary or seasonal work?
Full-Time
Part-Time
Temporary
Seasonal Work
If part-time, what days and hours?
If temporary or seasonal, what period of time?
Are you capable of satisfactorily performing the essential job tasks of this position, with or without accommodation, for which you are applying?
Yes
No
If No, please explain:
Will you accept out-of-town assignments of up to two – three weeks?
Yes
No
Would you relocate?
Yes
No
If employed, can you provide proof that you are legally permitted to work in the United States?
Yes
No
Will you abide by rules of this company?
Yes
No
Have you ever been disciplined for violating company rules or regulations?
Yes
No
If Yes, explain
How many days of work have you missed in the last two years?
How many times have you been late for work in the last two years?
Would you be willing and able to report to work “on time” every day on a regular and consistent basis?
Yes
No
NCI is an equal opportunity / affirmative action employer
- Our Affirmative Action Plan has been designed to make all employees and potential employees aware that they will receive fair consideration when seeking any Company job that they can perform or can readily learn to perform. The Plan does not provide for the hiring or promotion of individuals who cannot perform the job. It simply assures every individual equal employment opportunities without regard to their national or racial origin, sex, age, religion or any physical disability that does not prevent their performance of the job.
EDUCATION / TRAINING
High School*
Years Completed
Did you Graduate?
Degree/Diploma
Location
Course/Training
Business, Tech, Or Trade School*
Years Completed
Did you Graduate?
Degree/Diploma
Location
Course/Training
College or University*
Years Completed
Did you Graduate?
Degree/Diploma
Location
Course/Training
Graduate School*
Years Completed
Did you Graduate?
Degree/Diploma
Location
Course/Training
Upload Resume
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Start with most recent employer. Give employment record as completely as possible, include U.S. military service.
For any unemployment or self-employment periods show dates and location. Insert an additional sheet if necessary.
May we contact the employers listed in your resume?
Yes
No
Are you a veteran of U.S. Armed Forces?
Yes
No
If Yes, Which branch?
Service schools and other special training:
List computer skills and software with which you are proficient:
List only CURRENT licenses and professional registrations (If hired, copies must be provided):
Describe the types of duties and tasks performed in each reported job position listed on previous page. Our ability to evaluate your experience depends largely upon the information provided here.
PROFESSIONAL REFERENCES (NOT RELATIVES)
Name
*
Address
Phone Number
Name
*
Address
Phone Number
Name
*
Address
Phone Number
READ AND INITIAL THE FOLLOWING STATEMENTS. SIGN ONLY AFTER THE ENTIRE APPLICATION HAS BEEN COMPLETED.
1. The information that I have provided on this application is accurate, true and complete.
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2. I understand and agree that any misrepresentation or omission of a material fact in my application may result in refusal of employment or, if employed, termination of employment from the Company.
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3. I understand that, if employed with the Company, my employment will be conditioned upon my submission of proof of my identity and authorization to work in the United States in accordance with the Immigration Reform Control Act, as amended.
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4. I understand that this application is not a promise of employment.
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5. I understand that, if employed by the Company, I may be required to work overtime hours or hours outside a normally defined work day or work week.
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6. I understand that if I am hired, my employment is “at-will” and will be for no definite period of time, regardless of the period of the payment of my wages. I further understand that I have the right to terminate my employment at any time, with or without notice, and the Company has the same right. No one other than the President of the Company or his designee has authority to modify this relationship or to make any agreement to the contrary. Any such modification or agreement must be in writing. I acknowledge that no Company representative has made any promises or agreements that are in conflict with this “at-will” employment relationship.
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7. Note: Past criminal history may be inquired into during the employment interview process.
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***I acknowledge that I have read the entire form and understand it. I have placed my initials beside Paragraphs 1 through 7 above, to confirm that I have read and understand and agree to each paragraph.***
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