Application for Employment

Equal access to programs, services and employment opportunities is available to all persons without regard to age, ancestry, color, disability, genetic information, gender, gender identity, gender expression, marital status, medical condition, military or veteran status, national origin, race, religion, sex (including pregnancy, childbirth, breastfeeding and/or related medical conditions), sexual orientation, or any other basis protected by federal, state, and/or local law.

In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations for the application and/or interview process should notify the Human Resources Department. Examples of reasonable accommodations include making a change to the application process; providing written materials in an alternate format such as braille, large print, or audio recording; using a sign language interpreter; using specialized equipment; or modifying testing conditions.

Notice to applicants and employees: Screening tests for illegal drug use are required before hiring and may be required during your employment here.

Your name *

First

Middle

Last

Your phone number

Your email address

Your address

Street address, city, state, and zip

Position(s) applied for

Referral source

(e.g. walk-in, friend/family member, job posting, social media, LinkedIn, etc.)

If necessary, best time to call you is:

May we contact you at work?

• Yes
• No

If yes, best time to call:

Work phone number

If you are under 18 and it is required, can you furnish a work permit?

• Yes
• No

If not, please explain:

Have you submitted an application to South Bay Cable before?

• Yes
• No

If yes, give date(s) and position(s):

Have you been employed by South Bay Cable before?

• Yes
• No

If yes, please give dates:

Is this application a request for reemployment following an extended military leave of absence from South Bay Cable?

• Yes
• No

If yes, additional information may be requested.

Are you lawfully authorized to work in the United States?

• Yes
• No

Date available to start work:

What is your desired salary range?

please note per hour, week, month, year, etc.

Will you relocate if the job requires it?

• Yes
• No

Will you travel if the job requires it?

• Yes
• No

If they have been explained to you, are you able to meet the attendance requirements of the position?

• Yes
• No
• N/A

Will you work overtime if desired?

• Yes
• No

If no, please explain:

Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)? (This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.)

• Yes
• No
• Need more information about the job’s “essential functions” to respond

Driver's license number:

(if driving may be required in the job for which you are applying)

Driver's license issuing state:

Have you ever been bonded?

• Yes
• No

Have you ever entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company?

• Yes
• No

If yes, please explain:

1) Past employer

Starting with most recent employer

Past employer phone number

Past employer address

Street address, city, state, and zip

Starting job/title and final job/title

Dates employed

From date 00/00/000 – to date 00/00/0000

Immediate supervisor and title

For the most recent position held

May we contact for reference?

• Yes
• No

Supervisor's email

Why did you leave?

Summarize the type of work performed and job responsibilities:

What did you like most about the position?

What did you like least about the position?

2) Past employer

Past employer phone number

Past employer address

Street address, city, state, and zip

Starting job/title and final job/title

Dates employed

From date 00/00/000 – to date 00/00/0000

Immediate supervisor and title

For the most recent position held

May we contact for reference?

• Yes
• No

Supervisor's email

Why did you leave?

Summarize the type of work performed and job responsibilities:

What did you like most about the position?

What did you like least about the position?

3) Past employer

Past employer phone number

Past employer address

Street address, city, state, and zip

Starting job/title and final job/title

Dates employed

From date 00/00/000 – to date 00/00/0000

Immediate supervisor and title

For the most recent position held

May we contact for reference?

• Yes
• No

Supervisor's email

Why did you leave?

Summarize the type of work performed and job responsibilities:

What did you like most about the position?

What did you like least about the position?

4) Past employer

Past employer phone number

Past employer address

Street address, city, state, and zip

Starting job/title and final job/title

Dates employed

From date 00/00/000 – to date 00/00/0000

Immediate supervisor and title

For the most recent position held

May we contact for reference?

• Yes
• No

Supervisor's email

Why did you leave?

Summarize the type of work performed and job responsibilities:

What did you like most about the position?

What did you like least about the position?

Explain any gaps in your employment, other than those due to personal illness, injury, or disability:

If not addressed in the past employment questions, have you ever been fired or asked to resign from a job?

• Yes
• No
• Explained above

If yes, please explain:

Summarize any special training, skills, languages, licenses, and/or certificates that may assist in performing the position for which you are applying:

Word processing skills:

• Yes
• No

If yes, answer next two questions. If no, go on to “Spreadsheet skills.”

Word processing software:

List applications you have experience using

Word processing application experience levelBasicIntermediateAdvanced

Spreadsheet skills:

• Yes
• No

If yes, answer next two questions. If no, go on to “Presentation skills.”

Spreadsheet software:

List applications you have experience using

Spreadsheet application experience levelBasicIntermediateAdvanced

Presentation skills:

• Yes
• No

If yes, answer next two questions. If no, go on to “Presentation skills.”

Presentation software:

List applications you have experience using

Presentation application experience levelBasicIntermediateAdvanced

Email skills:

• Yes
• No

If yes, answer next two questions. If no, go on to “Presentation skills.”

Email software:

List applications you have experience using

Email application experience levelBasicIntermediateAdvanced

Internet skills:

• Yes
• No

If yes, answer next two questions. If no, go on to “Presentation skills.”

Internet software:

List applications you have experience using

Internet application experience levelBasicIntermediateAdvanced

Other skills:

• Yes
• No

If yes, answer next two questions. If no, go on to “Presentation skills.”

Other software:

List applications you have experience using

Other application experience levelBasicIntermediateAdvanced

Other skills:

• Yes
• No

If yes, answer next two questions. If no, go on to “Presentation skills.”

Other software:

List applications you have experience using

Other application experience levelBasicIntermediateAdvanced

1) Education attained

Starting with the most recent school attended

Number of years attended

Selected Value: 0

Completed

• Diploma
• GED
• Certification
• Degree
• Other

If "other," explain:

GPA class rank

Major/minor

2) Education attained

School name

Number of years attended

Selected Value: 0

Completed

• Diploma
• GED
• Certification
• Degree
• Other

If "other," explain:

GPA class rank

Major/minor

3) Education attained

School name

Number of years attended

Selected Value: 0

Completed

• Diploma
• GED
• Certification
• Degree
• Other

If "other," explain:

GPA class rank

Major/minor

Reference #1

List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Title

Relationship to you

Phone number

Reference email

Number of years known

Selected Value: 0

Reference #2

Title

Relationship to you

Phone number

Reference email

Number of years known

Selected Value: 0

Reference #3

Title

Relationship to you

Phone number

Reference email

Number of years known

Selected Value: 0

To what job-related organizations (professional, trade, etc.) do you belong?

When answering these questions, please exclude any information that would reveal age, ancestry, color, disability, genetic information, gender, gender identity, gender expression, marital status, medical condition, military or veteran status, national origin, race, religion, sex (includes pregnancy, childbirth, breastfeeding, and/or related medical conditions), sexual orientation, or other similarly protected status.

List special accomplishments, publications, awards, etc.

List any relevant volunteer work

Is there any other job-related information you want us to know about you?

Application Statement: I certify that all information I have provided in order to apply for and secure work with South Bay Cable is true, complete, and correct. I expressly authorize, without reservation, South Bay Cable, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding South Bay Cable, its agents, employees, or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law. I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notices, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period of definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are they are in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer. This company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her age, ancestry, color, disability, genetic information, gender, gender identity, gender expression, marital status, medical condition, military or veteran status, national origin, race, religion, sex (includes pregnancy, childbirth, breastfeeding, and/or related medical conditions), sexual orientation or any other protected status under applicable federal, state, or local law. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminated me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered. *

• Yes

Do you certify that you have read, fully understand, and accept all terms of the foregoing Application Statement?

Drug test consent: I, a prospective employee of South Bay Wire and Cable Company, LLC, ("the Company"), understand that the use of drugs, alcohol, and other controlled substances by employees creates a dangerous work environment. In consideration of my desire for a safe work environment, I hereby give my consent for the Company to conduct the drug tests it considers necessary. I understand that this drug test is a condition for employment, and that I may be drug tested at any time during my employment with the Company in accordance with the Company's Drug Free Workplace Policy. I understand that if my drug test is positive for controlled substances, my offer of employment will be rescinded. I hereby allow the drug testing facility which the Company has selected to take the necessary specimens from me to test for any controlled substance, and I authorize the laboratory or medical personnel retained by the Company for these tests to release the results to the Company for whatever use the Company deems appropriate. Further, I release the laboratory or medical personnel conducting the drug test, the Company, and the Company's employees, directors, officers, and successors from any liabilities, claims, and causes of action, known or unknown, contingent, or fixed, that may result from this drug test. I agree not to file any lawsuit or other action to assert a claim. *

• Yes

I have read and understood this agreement, and I consent without any coercion or duress by any individual or institution.

Submit