Registration: TekSolv

If you have not yet registered for access to our online scheduling system, please complete the following form.

* required field
APPLICANT INFORMATION
 

ADDITIONAL INFORMATION
* How did you hear about us?
* What position you are applying for?
* Social Security Number

Person to Contact in the event of an Emergency:

* Emergency Contact Name
* Emergency Contact Relationship
* Emergency Contact Phone Number

Education Information

Complete all that apply.

College/University
College/University Address
College/University Dates Attended
College/University Major
College/University Graduation Date

Business/Trade
Business/Trade Address
Business/Trade Dates Attended
Business/Trade Major
Business/Trade Graduation Date


High School
High School Address
High School Dates Attended
High School Major
High School Graduation Date

Other School
Other Address
Other Dates Attended
Other Major
Other Graduation Date

Employment History

Starting with the most recent employment, list your last three employers. Include self-employment, summer, and part-time jobs. If more space is needed attach a separate sheet.

* 1. Employer Name and Address
* 1. Telephone Number
* 1. Supervisor Name and Title
* 1. Dates Employed (from)
* 1. Dates Employed (to)
* 1. Weekly Pay (start)
* 1. Weekly Pay (end)
* 1. Job Title and describe type of work
* 1. Reason for leaving




2. Employer Name and Address
2. Telephone Number
2. Supervisor Name and Title
2. Dates Employed (from)
2. Dates Employed (to)
2. Weekly Pay (start)
2. Weekly Pay (end)
2. Job Title and describe type of work
2. Reason for leaving

References

List three business references who are not related to you and have knowledge of your qualifications

First Reference Name
First Reference Address
First Reference Phone
First Reference Relationship

Second Reference Name
Second Reference Address
Second Reference Phone
Second Reference Relationship



Third Reference Name
Third Reference Address
Third Reference Phone
Third Reference Relationship

General Information
* In the past 10 years, have you have been convicted of a felony?
 Yes  No
If yes, explain:

* In the past 10 years, have you received any traffic violations?
 Yes  No
If yes, explain:

* Do you have a valid Driver's License?
 Yes  No
* Indicate state and license number
* Have you received any moving violations?
 Yes  No
If yes, provide details:
* Do you currently hold a CDL?
 Yes  No
* Are you able to perform the essential functions of the job?
 Yes  No
If no, explain:

Note: You are not required to disclose any physical or mental limitation you may have. However, if you want us to consider a reasonable accommodation please indicate in the space above.

List current professional licenses or certificates:


Indicate expiration date and licensing authority

1.
2.
3.

EOE Information
TekSolv is an Equal Opportunity Employer. As required by law, we must record certain information to be made a part of our Affirmative Action Program. Applicants for employment are also invited to participate in the Affirmative Action Program by reporting their status as disabled, disabled veteran, veteran of the Vietnam era or other minority. In extending this invitation you are also advised that: (a) workers (applicants) are under no obligation to respond, but may do so in the future if they choose; (b) responses will remain confidential within the Human Resources Department; and (c) responses will be used only for the necessary information to include in our Affirmative Action Program. We are a company that values diversity. We actively encourage women and minorities to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment. Please complete the information requested below. Thank you for your cooperation.
Section 1: General Applicant Information
Name
Position applied for:
Date
Section 2: Please check (4) all that apply (See below for definitions)
Race or Ethnic Identity
Hispanic or Latino
White (not Hispanic or Latino)
Black or African American (not Hispanic or Latino)
Native Hawaiian or Pacific Islander (not Hispanic or Latino)
Asian (not Hispanic or Latino)
American Indian or Alaskan Native (not Hispanic or Latino)
Two or More Races (not Hispanic or Latino)
I do not wish to Self-Identify
Gender
Male
Female
**Veteran Status
Vietnam Era Veteran
Disabled Veteran
Special Disabled Veteran
Other Protected Veteran
Recently Separated Veteran
Armed Forces Service Medal Veterans
Type in name for signature
How did you hear of our opening?
Current Employee
Newspaper Ad
Recruiter
Other
If other please elaborate.
EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) - A person having origins in any of the original peoples 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 Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain 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. Individual with Disabilities - Defined as a person who (1) has a physical or mental impairment which substantially limits one or more of his or her major life activity(s), (2) has a record of such impairment(s), or (3) is regarded as having such impairment(s). For purposes of this definition, an individual with disability(s) is substantially limited if he or she is likely to experience difficulty in securing, retaining, or advancing in employment because of the disability(s). Veteran of the Vietnam-Era - Defined as (a) an active duty wartime or campaign badge veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of Defense. (b) an Armed Forces service medal veteran veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 FR 1209). Disabled Veteran - Defined as (1) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) a person who was discharged or released from active duty because of a service-connected disability. Special Disabled Veteran - Defined as a veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans Affairs for a disability: 1. Rated at 30 percent or more; or 2. Rated at 10 or 20 percent in the case of a veteran who has been determined under 38 U.S.C. 3106 to have a serious employment handicap; or 3. A person who was discharged or released from active duty because of a service-connected disability. Veteran of the Vietnam Era - Defined as a person who served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred: 1. In the Republic of Vietnam between February 28, 1961, and May 7, 1975; or 2. Between August 5, 1964, and May 7, 1975, in all other cases; or 3. Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed In the Republic of Vietnam between February 28, 1961, and May 7, 1975; or between August 5, 1964, and May 7, 1975, in all other cases. Recently Separated Veteran - Any veteran who served on active duty in the U.S. military, ground, naval or air service during the one year period beginning on the date of such veteranĂ¢€™s discharge or release from active duty. Pre-JVA Veteran - Defined as an individual who is an employee of or applicant to a contractor with a contract of $25,000 or more entered into prior to December 1, 2003 and unmodified since to $100,000 or more, and who is a special disabled veteran, veteran of the Vietnam era, pre-JVA recently separated veteran, or other protected veteran. Armed Forces Service Medal Veteran - Defined as any veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. Active Duty or Wartime Campaign Badge Veteran - Defined as a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized, under the laws administered by the Department of Defense.



Thank you for your interest!
 
 
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