Employment Application

Please review application carefully. We will not consider this application if not completed in full.

Please Check if under 18 years of age.
Date
Last Name	First Name	M.I.
Address		Apt
City	State	Zip
Home Phone	Work Phone
Email

Availability

Position Desired
Date Available
Desired Salary
Type of Employment Desired?	Full-TimePart-TimeTemporary 1^st Shift2^nd Shift3^rd Shift
Are you legally eligible for employment in the United States?	YesNo
Have you ever submitted an application to Spectrum Control, Inc.?	YesNo
Have you worked previously for Spectrum Control Inc. or any of its subsidiaries?	YesNo
How did you learn about Spectrum Control, Inc.?	AdvertisementFriendWalk-In EmployeeOther

Education

	Name	City/State	Graduate?	Degree
High School
Business, Trade or Technical
College
Other

Special Licenses / Certificates / Clearances which You Hold

Type	Issued By	Date Issued	Expiration Date	Number

Previous Employers

Please Note: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contract previous employers, the correct telephone numbers of past employees are critical. Ask for a phone book or call information if necessary. For employees outside the U.S.A., current fax number is mandatory.

1. Present/Most Recent Employer

Company Name

Address

Telephone

Job Title

Immediate Supervisor and Title

Type of Employment

Full TimePart TimeTemporaryOther

Reason for Leaving

Dates Employed			Hourly Rate/Salary		Hourly Rate/Salary
From Mo/Yr	To Mo/Yr		Starting ($/per)		Final ($/per)

Duties

Are you currently working for this employer? YesNo

May we contact for a reference? YesNo

2. Next Previous Employer

Company Name

Address

Telephone

Job Title

Immediate Supervisor and Title

Type of Employment

Full TimePart TimeTemporaryOther

Reason for Leaving

Dates Employed			Hourly Rate/Salary		Hourly Rate/Salary
From Mo/Yr	To Mo/Yr		Starting ($/per)		Final ($/per)

Duties

3. Next Previous Employer

Company Name

Address

Telephone

Job Title

Immediate Supervisor and Title

Type of Employment

Full TimePart TimeTemporaryOther

Reason for Leaving

Dates Employed			Hourly Rate/Salary		Hourly Rate/Salary
From Mo/Yr	To Mo/Yr		Starting ($/per)		Final ($/per)

Duties

Skills and Qualifications

Summarize specific skills and qualifications acquired from employment or other experiences that are related to the position for which you are applying (e.g., computer skills, software applications, and foreign languages).

Security

Have you been convicted of, or served time for a felony in the past seven years? YesNo

Describe Incidents Below	City/State	Charge

Have you used any names other than given on previous pages? YesNo

Previous Name(s)

References

Please list three professional references we may contact who have knowledge or your qualifications for this position. Please name persons to whom you are not related and who can attest to your educational and employment experiences.

Name	Position	Work Phone

Address	City	State

Name	Position	Work Phone

Address	City	State

Name	Position	Work Phone

Address	City	State

Equal Employment Opportunity Survey

Submission of this information is voluntary and will not be included in your application file.
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Spectrum Control, Inc. is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, Spectrum Control, Inc. invites applicants to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.

Date
Last Name		First Name	M.I.
Gender	MaleFemale	Position

Racial / Ethnic Data: Please identify yourself in terms of the racial / ethnic group below.

	Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish cutlure of origin regardless of race.
	White (Not Hispanic or Latino): A person having origins in any of the original people of Europe, the Middle East, or North Africa.
	Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.
	Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
	Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent. Including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
	American Indian or Alaskan Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.
	Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.
	Choose Not to Disclose

Certification and Release
Please read the following statements carefully, as they constitute conditions for employment with Spectrum Control, Inc. (“Spectrum”)

I affirm that the information I have provided on this application is complete, accurate and true to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information on this application or during this interview process, regardless of when such representation or omission is discovered, may result in refusal of employment, or if employed, shall constitute grounds for immediate termination.

I authorize Spectrum to contact any references, former employers, educational institutions and law enforcement agencies to provide any and all information in connection with this application. I hereby waive and release all persons, schools, current and prior employers, law enforcement agencies and other organizations from any liability arising from the disclosure of any of the above information, whether in writing or orally, and further waive and release Spectrum from any publication, or retention of such information within the context of its applicant-review procedures. I am willing that a photocopy of this authorization be accepted with the same authority as an original.

In the event that I am employed, I understand that I am required to abide by all rules and regulations of Spectrum and that the policies and procedures relating to conditions of employment are subject to modification at any time. Furthermore, I understand that if I receive an offer from Spectrum, I may be required to fill out a medical history form and/or obtain a medical examination which may include one or more drug screening tests. I agree that the examining authority may disclose the findings of these examinations to Spectrum and that my confidential offer of employment is contingent on meeting the requirements of any such examination established by Spectrum within the specified time period.

I agree to protect Spectrum’s confidential information, trade secrets, and names or addresses of clients, and I will not disclose to Spectrum any confidential information of others.

I will be able, if hired, to certify that I am authorized to work in the United State of America, and understand that in accordance with the Immigration Reform Control Act that I will be required to proved timely documentation of identity and employment eligibility.

I understand that Spectrum is in no way obligated to provide employment and that I am in no way obligated to accept employment with the Company. Nothing in this application or in Spectrum’s policies and procedures are intended to create a contract of employment, expressed or implied, I understand and agree that if I am employed, I shall be on an at-will basis. As an at-will employee, I understand and agree that either Spectrum or I can terminate our employment relationship at any time for any reason with or with out advance notice and with or without cause. I understand and agree that, although over the course of my employment, other terms and conditions of employment may change, the at-will term of my employment will not change. I understand that no representative of Spectrum has any authority to make any agreement contrary to the foregoing or to enter into any agreement for employment for any specific period of time.

I have read and agree with the above statements.

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