Information labeled in purple is required. Incomplete information could disqualify you from further consideration (if you have nothing to enter into a required field, type 'none' or 'n⁄a'.) Please include additional pages as part of your attached resume if adequate room is not provided.
How did you learn of this opening? Newspaper Web Friend ⁄ Family Other If Other, please tell us how
First Name
Last Name
Address
City
State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip
Phone
Email
Desired Position Accounting Administrative Support Central Office ⁄ Network Technician Combination Technician Construction Customer Service Engineering ⁄ Drafting Facilities ⁄ Plant Records Human Resources IT (Information Technology) Receptionist Warehouse
Attach Resume
Are you over 18 years old? Yes No This field is required.
Are you legally eligible for employment in the United States? Yes No This field is required.
On what date would you be available for work?
Have you been convicted of a felony within the last 7 years? Yes No This field is required.
If yes, please explain. Conviction will not necessarily disqualify an applicant from employment.
Have you completed any special courses, seminars and/or training that would enable you to perform the position for which you are applying? Yes No This field is required.
If yes, please explain.
Do you belong to any professional, trade, business or civic organizations that deal with the position for which you are applying? Yes No This field is required.
REFERENCE 1
Name of Reference
Occupation
Relationship
How Long Known
City, State, Zip
REFERENCE 2
Begin with your present or most recent job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, marital status, handicap or other protected status. You may include another sheet as part of your attached resume (see above) if necessary.
May we contact your present employer? Yes No This field is required.
(If any employment was under a different name, indicate name.)
Most Recent Employer
Employer
City and State
Start Date (MM/YYYY)
End Date (MM/YYYY)
Supervisor Name and Phone #
Job Title and Work Performed
Starting and Final Wage Amounts
Reason for Leaving
Previous Employer
Describe your experience/proficiency with the following:
Installation (protectors, inside wiring, phones, multi-line systems, etc.)
Fiber and copper cable
Running jumper wires and changing line cards
Construction equipment
Locating cable
Analog & digital subscriber equipment
DMS-10 / DMS-100 equipment
Fiber terminals
Special circuits ⁄ DSL equipment
Key systems
CopperCom switches
Voice mail systems
AP equipment
Private line & Broadband loop carrier equipment
Windows Operating System
Server Operating Systems
Network Security
Open source software, including Linux
Troubleshooting PC’s and LAN connections
Maintenance of Servers and LAN
Creation and maintenance of PERL⁄PHP⁄shell scripts
Operating multi-line phone system
Personal computer
CAD plotter
Staking sheets
Right-of-Way
Fiber splicer
Fork lift certification
Cable testing equipment
Central Office equipment
Customer Service experience
Databases
General Accounting
Human Resources
List any other experience, skills or qualifications including hobbies, which you feel may be relevant in evaluating your qualifications for employment. Indicate any job related military service.
Consistent attendance and punctuality are essential requirements of every job with this company. Is there anything which would interfere with your regular attendance and punctuality if you are offered a job with the company? Yes No This field is required.
Do you have a valid driver's license? Yes No This field is required.
Do you have a valid commercial driver's license? Yes No This field is required.
List any additional equipment (office or mechanical) you can efficiently operate.
List software programs that you are proficient in.
Please provide a short narrative detailing why you are qualified to fill this position.
Use the space below to add any other comments you believe are relevant to your consideration.
3 Rivers Communications is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, 3 Rivers invites applicants to voluntarily self-identify their gender and race or ethnicity. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including our Affirmative Action Plan. When reported, data will not identify any specific individual.
Gender: Male Female
Indicate The Appropriate Race ⁄ Ethnic Group: White Black ⁄ African American American Indian or Alaskan Native Asian Hispanic or Latino (All Races) Hispanic or Latino (White Race Only) Hispanic or Latino (All Other Races) Native Hawaiian or Other Pacific Islander
Please read carefully before submitting your application: All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information, I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified.) Regardless of whether or not I become employed by the company, I recognize that this application is not and should not be considered a contract of employment. I understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other that an officer or official of the company, and then only by means of a signed written document. We have a policy of no smoking inside company buildings or inside company vehicles.
Check this box to certify that you have read and accept the above statement.
