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  Online Application Form

Last Name
 First Name(s)
 E-mail Address
Address
 Street
 Apt. No
 Home Phone Number
City
 State
 Zip Code
 Business Phone Number
Position being applied for?
 Date available to begin work
 
 
Are you aware of any reason which would prevent you from being bonded if required?
Yes    No
Were you ever employed by Autometric or one of its subsidiary companies?
Yes    No
Is any member of your family currently employed by Autometric? If yes, state name, department and relationship.
Yes No
If yes, which company
Location
Dates
Educational Background
High School
Grade Completed Date
College
Certificate/Diploma Completed Date
University
Degree Completed Date
Other
Work Related Skills
Computer With what microcomputer hardware and software do you have working level skills?
Equipment With what other special machines or equipment do you have working level skills?
Other List any pertinent information not included above which you feel relates to your suitability for employment.
Employment Record
 
1. Dates:
From
To:
Company:
Address:
Name of Immediate Supervisor
Telephone:
Position held:
For employment purposes, may we contact:
Yes No
Final salary:
Reason for leaving: 		Duties & Responsibilities
2. Dates:
From
To:
Company:
Address:
Name of Immediate Supervisor
Telephone:
Position held:
For employment purposes, may we contact:
Yes No
Final salary:
Reason for leaving: 		Duties & Responsibilities
 
1.
I acknowledge that I have read, fully completed and understand all of this application form.   I hereby certify that the foregoing information is true, complete in every respect and I understand and agree that any false or inaccurate statements or omissions can constitute just cause for dismissal from the employ of the company.
2. I hereby consent to the Company making inquiries that may be necessary in order to verify the information I have provided and release any and all respondents to such inquiries from all liability which may arise from disclosure of such information.
 
Date:
 Name:
 
  
 

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