Progressive Communications: Application

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Job Application

Pre-Employment Questionnaire

Equal Opportunity Employer

Personal Information

Date of Birth:

First Name:

Last Name:

Social Security No:

Present Address

City:

State:

Zip Code:

Permanent Address:

City:

State:

Zip Code:

Phone No:

Referred By:

Employment Desired

Position:

Date you can start:

Salary Desired:

Are you employed?

Yes

If so, may we inquire of your present employer?

Yes

Ever applied to
this company before?

Yes

Where?

When?

Education History

	Name And Location Of School	Year Attended	Did You Graduate	Subject Studied
High School:
College:
Trade or Business School:
Other:

General Information

Subjects of special study / research work or special training / skills

U.S. Military or Naval service	Rank

Former Employer
(List Below Last Four Employers, Starting With Last One First)

Date Month And Year	Name & Address of Employer	Salary	Position	Reason for Leaving
From
To
From
To
From
To
From
To

References
Give below the names of three persons not related to you, whom you have known at least one year.

Name	Address	Business	Year Known

Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statement on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability- related or medical information in a manner pro-habited by the Americans with Disabilities Act(ADA) and other relevant federal and state laws.”

Date:

Digital Signature (please type your full name here):

Interviewed By:............................................................

Date:

....................................................

.................................. Administrative Use Only ..................................

Remarks

Neatness	Character
Personality	Ability

Hired

For Dept

Position

Will Report

Salary Wages

Approved:	1. .....................................................................
	Employment Manager
	2. ......................................................................
	Department Head
	3. ......................................................................
	General Manager

What WE OFFER
	Network Integration and Support	Security solutions	Healthcare facilities management
	Plant cabling and construction	Overhead paging and sound Systems	Joint Commission (JCAHO) Preparation
	Wireless Infrastructure Design and Integration	IP phone systems/video conferencing	Fire stop inspections and certification
	E-Rate implementation	Medical systems installation and integration	Patientmonitoring/telemetry installation

Call Us:
1-800-982-8315

Email Us: info@anscom.com

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