Job Position Applied For & ID Number * APPLICANT'S INFORMATION Email * Phone * Social Security Number * Driver's License Number * Are you at least 18 years old? * Who referred you to our company? Do you have any friends or relatives who work here? Have you applied to our company previously? * If hired, are you able to submit proof that you are legally eligible for employment in the United States? * Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation? * APPLICANT'S EMPLOYMENT HISTORY
List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.
* Employer 1 Employer’s Name: * Primary Job Duties: * Reason for Leaving: * * Employer 2 Employer’s Name: * Primary Job Duties: * Reason for Leaving: * * Employer 3 Employer’s Name: * Primary Job Duties: * Reason for Leaving: * APPLICANT'S EDUCATION AND TRAINING
List your current or most recent education first.
College/University 1 College/University Name: Did you receive a degree? If yes, indicate year of graduation and degree(s) received: College/University 2 College/University Name: Did you receive a degree? If yes, indicate year of graduation and degree(s) received: Other Training (graduate, technical, vocational) Other Training (graduate, technical, vocational): Did you complete your program? Please indicate any current professional licenses or certifications that you hold Notable Awards, Honors, Special Achievements: High School Name and Address Did you receive a degree? MILITARY SERVICE Are you a veteran of the US military? * Branch: Specialized Training: ADDITIONAL INFORMATION
Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:
Additional Information REFERENCES
List three non-relatives who would be willing to provide a reference for you.
Relationship * Relationship * Relationship * File Uploads
Please upload your resume and cover letter below, as a PDF or Plain Text files only.
Upload your resume *
PDF or plain text files only
Upload a cover letter *
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I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
I authorize, Birmingham Technologies, Inc. to perform a background check including but not limited to contacting former employers and educational organizations regarding my employment, education and certifications. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
If an employment relationship is created, I understand the relationship will be “at-will” in which either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Birmingham Technologies, Inc., except in a specific written contract of employment signed on behalf of the organization by its CEO, has the power to alter or vary the voluntary nature of the employment relationship.
I have carefully read the above verification and understand and agree to its terms.
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By selecting "Agree" using any device, means or action, you consent to the legally binding terms and conditions of this Certification. You further agree that your signature on this document is as valid as if you signed the document in writing.