Tilcon Connecticut Employment application form

Serving Connecticut's Communities Since 1923

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APPLICATION FOR EMPLOYMENT
* = required

GENERAL INFORMATION

* First Name

Middle Name

* Last Name

* Present Address:

* City	* State	* Zip

Email Address

* Home Phone

Work Phone

* Are you under age 18?
Yes No

* Are you legally eligible for employment in the U.S.?
Yes No

* Have you ever been convicted of any law violation other than minor traffic violations? (note: A yes answer does not necessarily disqualify you for employment)
Yes No

EMPLOYMENT DESIRED

Position Applied For:

Salary Desired:

How did you learn about the position (i.e., ad, agency, employee referral, etc.)?

Describe how your experience and skills qualify you for the position for which you are applying: (equipment, machines and or vehicles you can operate, special skills, etc.)

Date available to start work:

Shift Desired:

Drivers License, State & Number

If applicable for position: Any position driving a company vehicle requires that you present a valid drivers license upon offer of employment.

RECORD OF EDUCATION

High School (Name and City of School)

Course of Study:

Check Last Year Completed
9 10 11 12

Did You Graduate?
Yes NO GED

College (Name and City of School)

Course of Study:

Check Last Year Completed
1 2 3 4

Degree:

Did You Graduate?
Yes NO

Other (Name and City of School)

Course of Study:

Check Last Year Completed
1 2 3 4

Degree, Certificate, etc.:

Did You Graduate?
Yes NO

EMPLOYMENT HISTORY (Including Military Service)

* Present or Most Recent Employer:
* Company Name

Most Recent Employer Telephone:

* Address, City & State

Are you currently working for this employer?
Yes NO

If yes, may we contact?
Yes NO

Dates Employed (From/To)

Job Title

Supervisor

Duties

Salary PER (Hour, Week, Month)

Reason for Leaving

Employer:
* Company Name

Employer Telephone:

* Address, City & State

Dates Employed (From/To)

Job Title

Supervisor

Duties

Salary PER (Hour, Week, Month)

Reason for Leaving

Employer:
* Company Name

Employer Telephone:

* Address, City & State

Dates Employed (From/To)

Job Title

Supervisor

Duties

Salary PER (Hour, Week, Month)

Reason for Leaving

YOUR RESUME

Please copy and paste your resume (optional)

INVITATION TO VOLUNTARILY SELF-IDENTIFY

Tilcon Connecticut Inc. is an equal employment opportunity/affirmative action employer. Certain laws and regulations regarding equal employment opportunity/affirmative action require us to compile annual statistical reports on applicants for employment. In order to comply with these laws and regulations, we are requesting your cooperation in completing this EEO Self Identification Questionnaire.

The information on this EEO Self Questionnaire is being requested and will be used solely for equal employment opportunity/affirmative action record-keeping and reporting purposes. Completion and submission of this questionnaire by you is voluntary. Please be assured that you will not be subjected to any adverse treatment if you do not provide this information requested. In the event that you do provide the information requested, the information from this questionnaire would be processed and maintained separately from your employment application forms and, if you are hired by the Company, your personnel file.

Gender

Veteran Status

Ethnicity

I understand that this employment application and any other company documents are not contracts of employment, and that any individual who is hired may voluntarily leave employment and may be terminated by Tilcon Connecticut Inc. at any time for any reason, other than a reason prohibited by law. I understand that any oral or written statements to the contrary are hereby expressly disavowed by Tilcon Connecticut Inc. and should not be relied upon (and I do not rely upon any such statements) by any prospective or existing employee. By signing this application, I agree to allow and authorize Tilcon Connecticut Inc. to conduct any investigation allowable by law into the information I provide, in this application. I understand that I must correct any statement that is inaccurate within 30 days of notification, or I will be terminated. I hereby certify that I have read this statement and agree to its terms.

I Accept - Clicking here indicates your consent and authorization for Tilcon Connecticut Inc. and its designated employees and consultants to collect and use the information you submit in considering you for job opportunities at Tilcon Connecticut Inc.

SUBMIT APPLICATION

Please verify that all information is complete and true then press the "submit application" button

© 2001 - 2005 - Tilcon Connecticut, Inc. - Main Office, P.O. Box 1357 - New Britain, CT 06050
Main Phone: 860-224-6005 | Main Fax: 860-225-1865
Sales Direct Phone: 860-612-3161 | Sales Direct Fax: 860-229-2029