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Employment Application

Currently seeking subcontractors for the following states; Georgia, Alabama, and Jacksonville, Florida. Scope of Work- Running coax, strain and fiber. Paying out 80% of the invoice. 10% held Retainage. 10% for Contract holder. All invoices paid after contractor receives payout

First Name*

Date

Address:

Street Address

Apartment/Unit #

City

State

ZIP Code

Phone

Email

Date Available

Social Security No

Desired Salary $

Position Applied for

Are you a citizen of the United States

Yes No

If no, are you authorized to work in the U.S?

Yes No

Have you ever worked for this company?

Yes No

If yes, when?

Have you ever been convicted of a felony?

Yes No

If yes, explain

High School

Address

From

To

Did you graduate?

Yes No

Diploma

Collage

Address

From

To

Did you graduate?

Yes No

Degree

Other

Address

From

To

Did you graduate?

Yes No

Degree

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes No

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes No

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Please upload image of your signature

Date

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