PCS Fiber Employment Application

How did you hear about us?

Position

Job position you're applying for: *

Personal Information

Telephone # Residence: *

Cell No.

Email: *

First Name: *

Middle Name:

Last Name: *

Please list any CDL Class, Endorsements, or Restrictions

Present Address: *

Present Street Address *

Address Line 2

City *

State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP *

Permanent Address: *

Permanent Street Address *

Address Line 2

City *

State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP *

In case of emergency, whom should we notify?

Emergency Contact Name: *

Street Address

Address Line 2

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP

Emergency Contact Phone: *

Emergency Contact Relationship: *

Employment Desired

Date you will be available for work:

Salary Desired

Are you currently employed? --- Yes No

If so, may we contact your employer? --- Yes No

If you have previously applied to this company before, please indicate when and position.

Do you have any relatives employed by this company? --- Yes No

If so, please list names:

If you have worked for this company before, please indicate when and position held.

Do you seek full or part time employment? * --- Full Time Part Time

List other names or aliases you have used:

If employed, can you provide proof of legal right to work in the United States? * --- Yes No

If no, please explain:

Have you ever been convicted, pled nolo contendere (no contest), been placed on probation, or had adjudication withheld for the commission of a crime (other than minor traffic violations, a "discharge" under Georgia's First Offender Statute, or a termination of the action pursuant to Section 160.50 of New York's criminal procedure law) in the United States or any foreign country as an adult or juvenile (minor) which has not been expunged, annulled, sealed, impounded or statutorily eradicated by the court? (Note: answering yes to this question will not necessarily be a bar to employment.)* --- Yes No

If yes, please explain in full with description of the case.

Do you have or anticipate any obligations which could conflict with a standard work schedule or performance of assigned duties? * --- Yes No

If yes, describe:

Are you willing to relocate? * --- Yes No

Would you be willing to travel (2 men to a room)? * --- Yes No

Are you willing to work any shift, including nights and weekends, and overtime?* --- Yes No

Job Related Skills

Indicate experience in years and months for each area.

Fusion Splicing

FO Terminations

CADD

FO Testing-OTDR/LS-PM

Bucket Truck

Tugger

List any other skills you think may be of value to PCS:

Employment History

Present or Most Recent Employer

Present or Most Recent Employer Company Name: *

Address:

Phone: *

Name/Title of Supervisor

Job Title: *

Ending Pay: *

Date Employed From: *

Date Employed Until: *

Type of work performed: *

Reason for leaving *

Previous Employer

Present or Most Recent Employer Company Name:

Address:

Phone:

Name/Title of Supervisor

Job Title:

Ending Pay: *

Date Employed From:

Date Employed Until:

Type of work performed:

Reason for leaving

Previous Employer

Present or Most Recent Employer Company Name:

Address:

Phone:

Name/Title of Supervisor

Job Title:

Ending Pay:

Date Employed From:

Date Employed Until:

Type of work performed:

Reason for leaving

Previous Employer

Present or Most Recent Employer Company Name:

Address:

Phone:

Name/Title of Supervisor

Job Title:

Ending Pay:

Date Employed From:

Date Employed Until:

Type of work performed:

Reason for leaving:

Other Employment

List part-time employment while in school, including company name(s), addresses, and dates of employment

Are there any periods of unemployment since you graduated or last attended high school which are not listed above? --- Yes No

If yes, please explain.

Please explain any gap in Employment History above.

Have you ever been suspended, placed on probation, asked to resign, discharged or terminated? --- Yes No

If yes, please explain.

Please explain any work related accomplishments you are especially proud of.

Hobbies, recreation, special interests:

Military Service

Branch:

MOS

Rank at Separation

Year of Duty From

Year of Duty To

Location

Discharge Type

Professional References

Please list three professional references you have known for at least one year.

1. Reference #1 Name: *

Address: *

Phone: *

Email:

Relationship: *

Years Known: *

Reference #2 Name: *

Address: *

Phone: *

Email:

Relationship: *

Years Known: *

Reference #3 Name: *

Address: *

Phone: *

Email:

Relationship: *

Years Known: *

Education History

Languages spoken:

Last High School Attended:

High School Name: *

High School City: *

High School State: *

Grade Completed: * --- 9 10 11 12 None

Date Attended From: *

Date Attended To: *

Junior College Attended:

Junior College Name:

City:

State:

Years Completed --- 1 2 3 4 None

Major:

Minor:

Date Attended From:

Date Attended To:

College or University Attended

College or University Name:

City:

State:

Years Completed --- 1 2 3 4 None

Major:

Minor:

Date Attended From:

Date Attended To:

Graduate School Attended

Graduate School Name:

City:

State:

Years Completed --- 1 2 3 4 None

Major:

Minor:

Date Attended From:

Date Attended To:

Trade School Attended

Trade School Name:

City:

State:

Years Completed --- 1 2 3 4 None

Major:

Minor:

Date Attended From:

Date Attended To:

Adult Education or Special Training:

Certifications Held

(i.e. BICSI, ETA, IMSA, ATSSA, CISCO, etc.)

Agency / Certification / Date Expires

Attachments

Use these fields to upload attachments such as resume, cover letter, etc.

Attachment #1:

Attachment #2:

Attachment #3: