Employment Application

Applicant Information

Name(Required)

First Middle Last

Address(Required)

Street Address or P.O Box City State Zip

Phone Number(Required)

Email Address(Required)

Position Applied for

Date Available(Required)

Desired Salary(Required)

Are you a citizen of the United States?(Required)

Yes

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

Yes

Have you ever worked for this company?(Required)

Yes

If yes, when?(Required)

Driver’s License number(Required)

Expires(Required)

Have you ever been convicted of a felony?(Required)

Yes

If YES, please explain(Required)

In this space describe why you are interested in working for Salina-Spavinaw Telephone Company.(Required)

References

Name(Required)

First Middle Last

Relationship(Required)

Company(Required)

Phone Number(Required)

Address(Required)

Street Address or P.O Box City State Zip

Name(Required)

First Middle Last

Relationship(Required)

Company(Required)

Phone Number(Required)

Address(Required)

Street Address or P.O Box City State Zip

Name(Required)

First Middle Last

Relationship

Company

Phone Number

Address

Street Address or P.O Box City State Zip

Previous Employment

Company(Required)

Phone Number(Required)

Address(Required)

Street Address or P.O Box City State Zip

Supervisor(Required)

Job Title(Required)

Starting Salary(Required)

Ending Salary(Required)

Responsibilities(Required)

From Date(Required)

To Date(Required)

Reason for Leaving(Required)

May we contact your previous supervisor for a reference?(Required)

Yes

Company(Required)

Phone Number(Required)

Address(Required)

Street Address or P.O Box City State Zip

Job Title(Required)

Starting Salary(Required)

Ending Salary(Required)

Responsibilities(Required)

From Date(Required)

To Date(Required)

Reason for Leaving(Required)

May we contact your previous supervisor for a reference?

Yes

Company

Phone Number

Address

Street Address or P.O Box City State Zip

Job Title

Starting Salary

Ending Salary

Responsibilities

From Date

To Date

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

Military Service

Type of Discharge

Rank at Discharge

Branch

From Date

To Date

If other than honorable, explain

Disclaimer and Signature

I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing which, if disclosed, would contradict the facts disclosed on this application.

I authorize my previous employers, schools and persons named as references to give any information regarding employment or educational record. I agree that this company shall not be held liable in any respect if a job offer is not extended, is withdrawn or my employment is terminated because of false statements, omissions, or answers made by me on this application. If I am employed with this company, I will comply with all rules and regulations as set forth in any communication distributed to employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I will be required to provide approved documentation that verifies my right to work in the United States on my first day of employment. I am in receipt of a list of approved documents which has been supplied with this application.

By signing this Notice, the applicant understands and voluntarily agrees to submit to pre-employment drug screening. The applicant further agrees to release the Company and its directors, officers, employees and affiliated concerns from any and all liability, claims, demands, damages and causes of action of every kind and nature arising out of the pre-employment drug screening and any decision concerning employment made by the Company, in whole or part, based upon the results of the pre-employment drug screen.

I understand that employment at this Company is “at-will,” which means that either I or the Company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is offered and is continued on that basis. I understand that no supervisor, manager or executive of the Company, other than the Board of Directors in a signed writing, has any authority to alter the foregoing.

I hereby acknowledge that I have read and understand the above statements.

Signature

Date

Applicant Information

Skills

Education

References

Previous Employment

Military Service

Disclaimer and Signature