We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, sexual identity or orientation, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws. THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIOP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. Applicant Information Applicant Name: Position Applying for: Available Start Date: Street Address: City, State, Zip Code: Telephone number: Your email Are you 18 years of age or older? YesNo Are you either a U.S. citizen or an alien authorized to work in the U.S.? YesNo Type of employment desired Full-timePart Time Hours you are available to work: Days of week you are available to work: Are you willing to work overtime? YesNo Have you previously applied for employment with Millennium Circuits Limited? YesNo If Yes, when did you apply? Have you ever been employed by MCL? YesNo If Yes, provide dates of employment, location, and reason for separation from employment. 250 How did you learn about this opening? 100 If applicable, below list any other names by which you have been known which may be necessary to allow us to confirm your work and educational record. For example, change of name, use of an assumed name, nickname, etc. Next Education and training Please mark as appropriate High School: School Name and Location (Address, City, State) Course of Study or Major Graduated? YesNo Number of years completed: Honors Received: College: School Name and Location (Address, City, State) Course of Study or Major Graduated? YesNo Number of years completed: Honors Received: Graduate/Professional: School Name and Location (Address, City, State) Course of Study or Major Graduated? YesNo Number of years completed: Honors Received: Trade: School Name and Location (Address, City, State) Course of Study or Major Graduated? YesNo Number of years completed: Honors Received: Other education, training, licenses, certifications, or special skills:: Are you able to use word processing, spreadsheet, accounting, internet, email, design for manufacturing and order processing system software? YesNo BackNextWork Experience Please list the names of your present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach additional sheets if needed. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Do not answer “See Resume.” Employer #1 Name Address Type of Business Telephone number: Date employed from: Dates employed to: Job Title: Duties: Supervisor's Name: May we contact? YesNo if No, Why Not? Wages Start: Wages Final: Reason for leaving? What will this employer say was the reason your employment terminated? Were you ever disciplined? If so, for what? How much notice did you give when resigning? If none, explain. Employer #2 Name Address Type of Business Telephone number: Date employed from: Dates employed to: Job Title: Duties: Supervisor's Name: May we contact? YesNo if No, Why Not? Wages Start: Wages Final: Reason for leaving? What will this employer say was the reason your employment terminated? Were you ever disciplined? If so, for what? How much notice did you give when resigning? If none, explain. Employer #3 Name Address Type of Business Telephone number: Date employed from: Dates employed to: Job Title: Duties: Supervisor's Name: May we contact? YesNo if No, Why Not? Wages Start: Wages Final: Reason for leaving? What will this employer say was the reason your employment terminated? Were you ever disciplined? If so, for what? How much notice did you give when resigning? If none, explain. Have you ever been terminated or asked to resign from any job? YesNo If Yes, how many times? Has your employment ever been terminated by mutual agreement? YesNo If Yes, how many times? Have you ever been given the choice to resign rather than be terminated? YesNo If Yes, how many times? If you answered Yes to any of the above three questions, please explain the circumstances of each occasion. 350 BackNextReferences: Please list the names of additional professional references (not listed above) we may contact. Reference #1 Name: Years Known: Street Address: City, State, Zip Code: Phone Number: Email Address: Occupation: Work Relationship: Reference #2 Name: Years Known: Street Address: City, State, Zip Code: Phone Number: Email Address: Occupation: Work Relationship: Reference #3 Name: Years Known: Street Address: City, State, Zip Code: Phone Number: Email Address: Occupation: Work Relationship: BackNextApplication Certification I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside. I understand that Millennium Circuits Limited (MCL) may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable, federal, state, or local law. If MCL has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company’s policy and federal, state, and local law may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company’s policies and applicable federal, state, and local laws. If employed by MCL, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise it’s right, without prior warning or notice, to conduct investigations of property (including, but not limited to files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property. I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement. I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal. THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE, OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENT – EXPRESS OR IMPLIED – WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTACT SIGNED BY THE PRESIDENT OF THE COMPANY. IF HIRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY THIS POLICY OF EMPLOYMENT AT-WILL. I authorize MCL or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking to the extent permitted by federal, state, and local law. I agree to complete any requisite authorization forms for the background investigation which may be permitted by federal, state, and/or local law. If applicable and allowed by law, I will receive separate written notification regarding the Company’s intent to obtain “consumer reports.” I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above- mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability MCL and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. Further, if hired, I authorize the Company to provide truthful information concerning my employment to future employers and hold the company harmless for providing such information. If hired by MCL, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. I also understand that MCL employs only individuals who are legally eligible to work in the United States. THIS APPLICATION WILL BE CONSIDERED ACTIVE TO A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY. I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND COMPLETE. Upload cover letter (optional): Upload resume (optional): DO NOT CHECK THIS BOX UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THE APPLICATION. Back
