Employment History

Please list ALL relevant work experience beginning with the most recent.

Employer Name:

Position/Title:

Street:

City:

State:

--United States-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PW RI SC SD SK TN TX UT VA VT WA WI WV WY --Canada-- AB BC MB NB NL NS NT NU ON PE QC YT --International - use "zz"-- zz

Zip:

Phone:

Supervisor/Reference Contact Information (someone that we can contact)

Name:

Phone:

Email:

Employment Details

Date From:   Date To:

Full or Part Time: Full     Part     Sub Contractor

Last Annual Salary:

Reason for Leaving:

Responsibilities/Accomplishments at this Position

May we contact this employer?: YES     NO

Employer Name:

Position/Title:

Street:

City:

State:

--United States-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PW RI SC SD SK TN TX UT VA VT WA WI WV WY --Canada-- AB BC MB NB NL NS NT NU ON PE QC YT --International - use "zz"-- zz

Zip:

Phone:

Supervisor/Reference Contact Information (someone that we can contact)

Name:

Phone:

Email:

Employment Details

Date From:   Date To:

Full or Part Time: Full     Part     Sub Contractor

Last Annual Salary:

Reason for Leaving:

Responsibilities/Accomplishments at this Position

May we contact this employer?: YES     NO

Employer Name:

Position/Title:

Street:

City:

State:

--United States-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PW RI SC SD SK TN TX UT VA VT WA WI WV WY --Canada-- AB BC MB NB NL NS NT NU ON PE QC YT --International - use "zz"-- zz

Zip:

Phone:

Supervisor/Reference Contact Information (someone that we can contact)

Name:

Phone:

Email:

Employment Details

Date From:   Date To:

Full or Part Time: Full     Part     Sub Contractor

Last Annual Salary:

Reason for Leaving:

Responsibilities/Accomplishments at this Position

May we contact this employer?: YES     NO

Do you have additional previous employers not listed above? YES     NO

Education

Please tell us about your educational background beginning with the most recent.

High School Attended (Name, City and State)

Graduation Status

H.S. Diploma GED or equivalent No Diploma or GED

Colleges, Universities and Technical Schools Attended:

Name and location:

Dates Attended:

Major area of study and number of semester hours

  Hrs:

Minor area of study and number of semester hours

  Hrs:

Degree

Date Conferred or Expected

Additional Information that your feel we should know in regards to your education

Name and location:

Dates Attended:

Major area of study and number of semester hours

  Hrs:

Minor area of study and number of semester hours

  Hrs:

Degree

Date Conferred or Expected

Additional Information that your feel we should know in regards to your education

Statement - Questions

Please answer the question(s) below. Responses should be concise.

Tip: Use your word processor to copy and paste in your answers. Copy your answers from the word processor and then hit CTRL+V for PC or OpenApple+V for Mac to paste.

Please explain how your past personal and professional experience make you a quality candidate for the position for which you are applying.

Specialized Skills and Knowledge

List skills or knowledge that show your ability to perform the job for which you are applying (such as typing speed, computer languages, catv installation, etc.

Communicate

Language proficiency other than English.

Do you know the English language? Yes No

Do you know any language other than English? Yes No

If yes, please indicate which language(s) and note your skill level below.

Oral Skills (Listening and Speaking)

Polite
Literate
Fluent

Written Skills (Reading and Writing)

Polite
Literate
Fluent

* Polite means being able to greet and exchange pleasantries; indicate or understand an
   emergency, or uncomfortable situation and ask if an interpreter is needed.
* One is literate if he/she can understand a newscast, or read a newspaper.
* One is fluent if he/she can clearly speak and write the language.

Reference

Please fill in your professional references: (Include only individuals who know of your work professionally.)

Name:

School/Org:

Current Position:

Relationship to Candidate:

Years Known:

Home Phone:

Cell Phone:

Work Phone:

Mailing Address:

Email:

Name:

School/Org:

Current Position:

Relationship to Candidate:

Years Known:

Home Phone:

Cell Phone:

Work Phone:

Mailing Address:

Email:

Name:

School/Org:

Current Position:

Relationship to Candidate:

Years Known:

Home Phone:

Cell Phone:

Work Phone:

Mailing Address:

Email:

Pre-Employment Screening

It is necessary that we know as much about you as possible in order to consider you for employment with our company. The following questions will

       assist us with our hiring process.

  1)       If required, would you agree to a physical examination to include pre-employment substance abuse testing.    YES   NO

  2)       Have you ever been convicted of or plead guilty to a criminal offense including theft of any kind or physical / sexual assault (other than a traffic violation) within the past 10 years?    YES   NO  If yes, please explain:

If yes, please explain

  3)       Please list any and all states that you have lived in the last 10 years:

 *R*

  4)       List any other names you have used in the past for employment or 

            educational purposes:

List any other names you have used in the past for employment or educational purposes

Supplemental Questions

Please answer the following questions

  1. Describe a time you had to deal with a difficult customer.  How did you handle

      the situation?

 *R*

2. Tell us about your experience working independently? How about within a

      team? Which do you prefer?  

 *R*

  3. Are you comfortable lifting 20-30lbs?

YES   NO

  4. Are you available to work nights, weekends and most holidays?  

YES   NO

  5. What else should we know about you?

 6. Are you currently Jones/NCTI Certified in:

    Core Video   YES  NO        HSI YES  NO

   CDV            YES  NO

   NOTE: A NO answer does not automatically disqualify you as a candidate for employment, as this

    employer WILL TRAIN the right candidate. If hired, and you are not currently Jones/NCTI Certified in

    all three of these fields, you will be required to take (and pass) these certification written tests after

    successfully completing your initial training period.

AGREEMENT - Please read Carefully

Please READ CAREFULLY before continuing any further

I hereby certify that I understand that this is NOT an Application for Employment, this is a ONLINE POSTING. I understand and agree that if I am contacted by any seeking employer in reference to my ONLINE POSTING on MyCableCaree.com, that I agree to complete and sign any and all of their normal pre-employment documents, to include an application for employment if required.

By posting this ONLINE POSTING, I understand that the PRE-EMPLOYMENT SCREENING section on this ONLINE POSTING is for information purposes only and does not constitute a contract between any company and myself.

I hereby certify that the information provided in my ONLINE POSTING is freely given, true, and complete. By submitting this ONLINE POSTING, I understand that making false statement(s) on this ONLINE POSTING, failing to meet any company standards for a medical evaluation or any background check(s) may be sufficient grounds for immediate employment disqualification or dismissal at any time.

In consideration for my employment with any company, I agree to conform to the rules and regulations of that company as set forth in the company’s employee handbook and acknowledge that these rules and regulations may be changed, interpreted, withdrawn, or be added to by the employer at any time, at the employer’s sole option and without any prior notice to me.

I consent to a physical examination, which includes a drug test, either prior to commencement of employment or after I have become employed, as deemed necessary by the employer.

I authorize any of the persons or organizations referenced in this ONLINE POSTING to give you and any of them all information concerning my previous employment, education, criminal background investigation, driving record or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this ONLINE POSTING, and I release all such parties from all liability for any damage which may result from furnishing such information to you.

<-- By selecting this checkbox you agree to the following terms and conditions as stated above and hereby state that you have read, understand, agree and accept the agreements in regards to your ONLINE POSTING.

Name:         July 17, 2009