Appointment

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PERSONAL DETAILS

Full Name (required)

Date of Birth

Address (required)

City (required)

State (required)

ZIP

Gender
MaleFemale

Contact numbers:

Home (required)

Mobile (required)

Fax

Email (required)

Vacancy Details

Reference:

Job Title:

For internal applications

Staff number:

Senior Manager:

Where did you see this vacancy advertised?

Have you attached any continuation sheets?
Any information which you think is relevant but is not covered elsewhere please write on a separate sheet and attach.

YesNo

EDUCATION

Type of School	Name and Location of School	Degree/Area of Study	Number of Years Attended	Graduated (Yes or No)

ACADEMIC AND PROFESSIONAL ACTIVITIES AND ACHIEVEMENTS

Academic and Professional Activities and Achievements, Awards, Publications or Technical-Professional Societies, indicate type or name.
Exclude organizations which indicate race, creed, color, sex, sexual orientation, gender identity, age, religion, disability, marital status or national origin of its members

SPECIAL SKILLS

Other Skills applicable to position applied for (e.g. computer proficiency)

What other languages do you speak fluently?

EMPLOYMENT HISTORY

List employment starting with your most recent position. Account for any time during this period that you were unemployed by stating the nature of your activities.

Dates	Name and Address of Employer	List Major Duties	Position Held and Supervisor

Have you ever been discharged from a job(s)? Yes or No. If yes, please provide details, including place(s) of employment, location(s), date(s), supervisor’s name(s), and circumstances of the discharge(s):

PERSON TO CONTACT IN CASE OF EMERGENCY

Full Name	Place of employment	Address	Phone

Please read this statement carefully

I hereby affirm that the information given by me on the application for employment is complete and accurate. I understand that any falsification or omission either on this application, or otherwise providing false information to the Company will be immediate grounds for dismissal, no matter when the falsification or omission is discovered. I authorize a thorough investigation to be made in connection with this application concerning my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, employment, education, and criminal record, whichever may be applicable for employment purposes. I understand this investigation may include personal interviews with third parties such as family members, business associates, financial sources, friends, neighbors, and others with whom I am acquainted. I further understand I have the right to make a written request within a reasonable period of time for complete and accurate disclosure of the nature and scope of the investigation.

It is my understanding that as a prerequisite to consideration for employment, I must agree to submit to any post-employment examinations, physical or other, as the Company may lawfully require. The Company will pay the reasonable cost of any such examination which may be required.

If I am hired, I agree that my employment and compensation can be terminated with or without cause, and without notice at any time, at the option of MY CELLPHONE REPAIRS or myself. I understand that, unless modified in written agreement signed by both me and the Vice President of Human Resources or the President of MY CELLPHONE REPAIRS , no representative of MY CELLPHONE REPAIRS has the authority to make any agreement for employment for a specified time or to make any other agreement contrary to the foregoing.

I have read and affirm as my own the above statements