Employment Application for Technology Dynamics Inc

Employment Application

Technology Dynamics, Inc. and its divisions (“Technology Dynamics”) is an equal opportunity employer. Technology Dynamics does not discriminate in employment with regard to race, color, religion, national origin, citizenship status, ancestry, age, sex (including pregnancy), sexual orientation, gender identity or expression, marital status, physical or mental disability, military status or any other characteristic protected by law.

PLEASE BE AWARE OF THE FACT THAT THE DETAILS FILLED IN THIS APPLICATION WILL BE VERIFIED BY BACKGROUND CHECKS AND CONTACTS WITH PREVIOUS EMPLOYERS

Date Filled (mm/dd/yyyy)*

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Email Address*

Date available?*

Are you available for full-time work?

Yes
No

If “No”, what hours can you work?

Are you available to work OT?

Yes
No

How did you hear about us?

Position Applied for:*

Are you able to perform the essential functions of the job, with or without accommodation?

Yes
No

If “No”, please explain:

Are you legally eligible to work in the United States?

Yes
No

Are you 18 years old or older?

If “No”, you may be required to provide authorization to work.

Yes
No

Have you ever been terminated or asked to resign by an employer?

Yes
No

If “Yes”, explain:

Do you have any relatives or friends that work for the Company?

Education

High School/GED:*

Address:

Did you graduate?*

Yes
No

College/University:

Address:

No. Years Completed:

Did you graduate?

Yes
No

Degree/Major:

Other/Trade:

Address:

Number of years completed:

Did you graduate?

Yes
No

Degree/Major:

Current/Previous Employment

Please provide complete information on current and/or former employment. Start with current or most recent employer.

Company:*

Phone:*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Supervisor:*

Job Title:*

Responsibilities:*

From:*

To:*

Reason for leaving:*

May we contact your previous supervisor for a reference?*

Yes
No

Company:

Phone:

Address:

Supervisor:

Job Title:

Responsibilites:

From:

To:

Reason for leaving

May we contact your previous supervisor for a reference?

Yes
No

Company:

Phone:

Address:

Supervisor:

Job Title:

Responsibilites:

From:

To:

Reason for leaving

May we contact your previous supervisor for a reference?

Yes
No

Other special training / skills / certifications

List special training / skills / certifications here:

References

Please list three (3) persons not related to you, whom you have known at least three (3) years.

Full Name:

Years Acquainted:

Company:

Phone:

Email:

Full Name:

Years Acquainted:

Company:

Phone:

Email:

Full Name:

Years Acquainted:

Company:

Phone:

Email:

Disclaimer*

Your application will be given the consideration it deserves; however, our acceptance of your completed application for our consideration does not mean that you will be offered employment. By signing your name below, you indicate your understanding that nothing contained in this application or any information gained or discussed during the interview process creates an employment contract between you and Technology Dynamics, Inc., and its divisions (the “Company”). If hired, you will be, at all times, an at-will employee. Should this application and the hiring process result in your employment, you have the right to terminate your employment at any time and for any reason. Likewise, the Company reserves the right to terminate your employment at any time and for any reason not prohibited by law.

When processing this application, and if applicable to the position for which you are applying, the Company may request third parties perform criminal, police, credit or other background checks about you. Should this be necessary, you will be given separate forms to fill out authorizing any such checks and setting forth information about your rights. In addition to these background checks, the Company may directly contact previous employers, supervisors and/or other persons listed in this application regarding the statements you make during the application process and your suitability for employment.

Also note, that should the Company hire you, the Company may use, at any time during your employment, outside agents or representatives to perform investigations surrounding any claim of wrongdoing, including but no limited to, sexual harassment, theft or fraud.

I certify with my signature below I have given the Company true and complete information on this application to the best of my knowledge. I have omitted no facts called for on the application and have not made any false statements. No requested information has been concealed. I authorize the Company to verify the accuracy of the statements and obtain reference information on my work performance. I release the Company from all liability of any kind, which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, if employed, any false statements or omissions of fact called for on this application could result in dismissal. I understand that should an employment offer be extended to me and accepted, I will at all times be an at-will employee. I will fully adhere to the policies, rules and regulations of employment. However, I further understand that neither the Company’s policies, rules, regulations or anything said during the interview process, shall be deemed to alter the at-will nature of my employment or to constitute the terms of an implied employment contract.

Please check this box as acceptance of the disclaimer above

Voluntary Self Identification Form

EEO-1 Voluntary Self Identification

The Equal Opportunity Commission (EEOC) requires all private employers with 100 or more employees as well as federal contractors and first-tier subcontractors with 50 or more employees AND contracts of at least $50,000 complete an EEO-1 report each year. Covered employers must invite employees to self-identify gender and race for this report.

Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by the Human Resources department.

If you choose not to self-identify your race/ethnicity at this time, the federal government requires the Company to determine this information by visual survey and/or other available information.

Gender

Male
Female

Race/Ethnicity:

(Please check one of the descriptions below corresponding to the ethnic group with which you identify)

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
Two or more races (Not Hispanic or Latino): All persons who identify with more than one of the above five non-Hispanic/Latino races.
I do not wish to disclose.

Voluntary Self Identification of Disability

OMB Control Number 1250-0005 | Expires 5/31/2023

Why are you being asked to complete this?

Technology Dynamics, Inc. and its divisions (the “Company”) is a federal contractor or subcontractor required by law to provide equal employment opportunity to qualified people with disabilities. We are also required to measure our progress toward having at least 7% of our workforce be individuals with disabilities. To do this, we must ask applicants and employees if they have or have ever had a disability. Because a person may become disabled at any time, we ask all of our employees to update their information at least every five (5) years.

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer will be maintained confidentially and not seen by selecting officials or anyone else involved in making personnel decisions. Completing the form will not negatively impact you in any way, regardless of whether you have self-identified in the past. For more information about this form or the equal employment obligations of federal contractors under Section 503 of the Rehabilitation Act, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:

Autism
Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis or HIV/AIDS
Blind or low vision
Cancer
Cardiovascular or heart disease
Celiac disease
Cerebral palsy
Deaf or hard of hearing
Depression or anxiety
Diabetes
Epilepsy
Gastrointestinal disorders, for example, Crohn’s Disease or irritable bowel syndrome
Intellectual disability
Missing limbs or partially missing limbs
Nervous system condition, for example migraine headaches, Parkinson’s disease or Multiple sclerosis (MS)
Psychiatric condition, for example, bipolar disorder, schizophrenia, PTSD or major depression

Please check one of the boxes below:

Yes, I have a disability, or have a history/record of having a disability.
No, I don’t have a disability, or have a history/record of having a disability.
I do not wish to answer.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

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Employment Application