- HALTEC Corporation

ONLINE APPLICATION

*Denotes Required Field

*First Name:

*Last Name:

*Address:

Address 2:

*City:

*State:

*Zip:

*Phone:

Date of Birth: Ex. mm/dd/yyyy

*Position you are applying for:

*Who referred you to this company?

*Relatives in Company employ:

*Have you worked for this company before?
YesNo

*Available to Work:
Full-timePart-time If Part-time enter days and hours:

EDUCATION

*High School:

*Highest Grade Completed:

College 1:

Highest Level Completed:

College 2:

Highest Level Completed:

Graduate School:

Business, Trade, or Other Schools:

Special Training:

Special Skills (Including machinery operation):

WORK HISTORY

Starting with your current or most recent employer, please list the following information about the last three companies for which you have worked:

*Employer 1:

*Address:

*Supervisor:

*Phone:

*Position Title:

*From: Ex. mm/dd/yyyy

*To: Ex. mm/dd/yyyy

*Responsibilities:

*Reason for Leaving:

*Employer 2:

*Address:

*Supervisor:

*Phone:

*Position Title:

*From: Ex. mm/dd/yyyy

*To: Ex. mm/dd/yyyy

*Responsibilities:

*Reason for Leaving:

WORK HISTORY - Continued

Employer 3:

Address:

Supervisor:

Phone:

Position Title:

From: Ex. mm/dd/yyyy

To: Ex. mm/dd/yyyy

Responsibilities:

Reason for Leaving:

SERVICE RECORD

Branch of Military Service - U.S.

National Guard:

Date obligation ends: Ex. mm/dd/yyyy

Type of Discharge:

Discharge Date: Ex. mm/dd/yyyy

PROFESSIONAL REFERENCES

Reference 1

*Name:

*Job Title:

*Company:

*Address:

*Phone:

*Work Relationship to Reference:

Reference 2

*Name:

*Job Title:

*Company:

*Address:

*Phone:

*Work Relationship to Reference:

Reference 3

Name:

Job Title:

Company:

Address:

Phone:

Work Relationship to Reference:

Resume:
* .doc, .txt and .pdf files accepted
1. Browse to select your resume2. Click the Upload button

Upload status: None

Applicant Consent

Please read each of the following statements and check each one to indicate that you understand and agree to the terms stated, then sign this form at the bottom.

*I certify that all information I have supplied on this form is correct to the best of my knowledge. I understand that omissions or deliberate misinformation will disqualify my application and, if hired, would serve as grounds for dismissal.

*I understand that nothing in this application creates an employment contract or relationship. I also understand that if hired by Haltec Corporation, my employment can be terminated at any time, by myself or Haltec Corporation, for any grounds not prohibited by law.

*I agree to allow Haltec Corporation to contact the people I have listed as references on this application. I also agree not to hold any references listed on this application liable for damages to any truthful information they provide regarding my qualifications for employment at Haltec Corporation.

Haltec Corporation is committed to providing equal employment opportunity for all employees and applicants regardless of race, color, religion, sex, age, national origin, citizenship status, disability, genetic information, or veteran status. Equal opportunity extends to all aspects of the employment relationship, including hiring, promotions, training, working conditions, compensation, and benefits. In all hiring and employment practices, EMPLOYER provides reasonable accommodations to qualified employees and applicants with disabilities unless the accommodations create undue hardship for Haltec Corporation.

*Signature

Entering your First Name + Middle Initial + Last Name will act as your digital signature.