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Excess Materials File
 
 
 
 Organized Flat Flex Wiring Solutions
 

2500 Davis Boulevard
Joplin, Missouri 64804
p. 417.781.4331
f. 417.781.9589
sales@midconcables.com
Copyright ©2007
MIDCON Cables Company
Privacy Policy

Employment Application Form

Midcon is an Equal Opportunity Employer. We encourage all qualified individuals to apply for employment. If you require accommodation to complete the application, testing or interview process, please contact the Human Resources Department.

Personal Information

Employment Desired

$

Education Attach additional pages as necessary

Name and Location of School

Years Attended

Diploma or Degree

Major, Subject, Award, Etc

Military Service

References list three people not you whom you have known at least one year

Name

Address

Phone Number

Relationship

Work expereince (Please list all work experience for the last ten years and your last three employers. Begin with your most recent employer attach additional as necessary)

  • $

    $

  • $

    $

  • $

    $

Special Qualifications


  1. Have you previously applied for employment at this company? If yes please explain:
  2. Do you have any relatives employed by this company or by any competitors? If yes please provide name(s), title(s) and company name(s).
  3. Have you been convicted or released from prison for violating and law other than minor traffic offenses in the past ten years?
  4. If yes please provide the reason for the conviction, the date, the city and state. A conviction record will not necessarily bar you from employment.

Please read and initial the following statements:

  • Accurate Information
    I certify that the information here and in my resume is true and complete. I understand that any incomplete, misleading or false information will disqualify my application or be cause for dismissal. I authorize the company to contact all references listed here and further investigate my work experience and qualification.
  • Conditions
    I understand that any offer of employment is contingent on the company's satisfaction with my: 1) drug test results; 2) identification and work authorization documents; 2) references and 4) background check.
  • Employment At Will
    I understand and agree that if I am hired my employment will be for no defined period and that it may be terminated by me or by the company at any time, with or without cause or notice. I also understand that the company may change my job responsibilities or change my position at its discretion. I further understand that these terms of employment cannot be changed, except in writing, signed by the company president.

Signature

Date


Midcon Cables

Applicant Information

Affirmative Action

Midcon Cables is a federal contractor (or subcontractor). As such, we are required to maintain demographic information about our applicants. We would appreciate your help in completing this form to ensure the accuracy of our information. This form is completely voluntary. It will be kept confidential, except as required to administer our Affirmative Action Plan.

Name Date
Job Objective
Referral Source

  1. Gender: Male Female

  2. Race: Please mark one or more of the following categories that best describes your ethnic background. (The definitions are government terms.)
    • Black - All persons having origins in any of the Black racial groups of Africa
    • Hispanic - All persons of Mexican, Puerto Rican, Cuban or South American or other Spanish culture, regardless of race.
    • Asian - All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.
    • Native American - All persons having origins in any of the original peoples of North America and who maintain cultural identification through tribal affiliation or community recognition. Meets Bureau of Indian Affairs definition standards.
    • White - Not covered above.

  3. Disability: I have a disability that restricts my ability to work: Yes No

    If yes please explain:


  4. Veteran: Please mark any of the following that apply:
    • Disabled Veteran (Receives 30% disability)
    • Vietnam Era Veteran (Republic of Vietnam service between 02/28/61 & 05/07/75; or military service between 08/05/64 & 05/07/75)