Employment Application

Please provide the requested information. Highlighted fields are required.

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Check which Job Opportunities you would like to apply for:

	Job Title	Location

High School

Major Studies

Degree, Diploma, License, or Certificate (list type and date)

Address

Vocation/Business/Other Major Studies

Degree, Diploma, License, or Certificate (list type and date)

Address

College/University Major Studies

Degree, Diploma, License, or Certificate (list type and date)

Address

College/University Major Studies

Degree, Diploma, License, or Certificate (list type and date)

Address

Graduate School Major Studies

Degree, Diploma, License, or Certificate (list type and date)

Address

Other Special Knowledge, Skills, Qualifications or Certifications (list any construction or manufacturing equipment, office skills, technical equipment or training, military experience)

For Clerical Applicants Only:

Do you Type?

Words Per Minute

List Computer Skills (hardware/software)

List all employers, starting with the present or most recent position. All information must be completed. You may attach a resume but not in place of the required information.

Present or Most Recent Employer

Employed From Date

Employed To Date

Job Title

Employer Name

Address

Supervisor's Name

Supervisor's Phone

Job Duties and Responsibilities

Reason for Leaving

May we contact this employer for references?
Yes No

Next Most Recent Employer

Employed From Date

Employed To Date

Job Title

Employer Name

Address

Supervisor's Name

Supervisor's Phone

Job Duties and Responsibilities

Reason for Leaving

May we contact this employer for references?
Yes No

Next Most Recent Employer

Employed From Date

Employed To Date

Job Title

Employer Name

Address

Supervisor's Name

Supervisor's Phone

Job Duties and Responsibilities

Reason for Leaving

May we contact this employer for references?
Yes No

Next Most Recent Employer

Employed From Date

Employed To Date

Job Title

Employer Name

Address

Supervisor's Name

Supervisor's Phone

Job Duties and Responsibilities

Reason for Leaving

May we contact this employer for references?
Yes No

Volunteer Activities (list organizations, type of service, dates)

Hobbies, Interests (optional)

How were you referred to Betacom?

Attach Resume

BETACOM INC. IS PROUD TO BE AN EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW.

I understand that Betacom Incorporated requires a background, criminal record and driving record checks for all finalists for a position. The background check will include verification of information provided on the completed application for employment, the applicant's resume or on other forms used in the hiring process. Information to be verified includes, but not limited to, social security number and previous addresses. The background check will also include a criminal record check and a driving record check. Additional checks, such as credit report may be made on applicants for particular job categories if appropriate and job related. The Company may also conduct a reference check and verification of the applicant's education and employment background as stated on the employment application or other documents listed above. Betacom Incorporated is a drug free workplace.

I authorize Betacom Incorporated to inquire into my education, past employment history, criminal record, driving record and references as needed to research my qualifications for this position.

Furthermore, I understand that Betacom Incorporated requires pre-employment drug testing and any offer of employment with the Company is contingent upon the job applicant successfully passing a drug test.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by Betacom Incorporated that such employment with Betacom Incorporated is at will, for no specified duration and may be terminated by either Betacom Incorporated or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of Betacom Incorporated or its representatives used during the employment process is deemed a contract of employment real or implied. In consideration for employment with Betacom Incorporated, if employed, I agree to conform to the rules, regulations, policies, and procedures of Betacom Incorporated at all times and understand that such obedience is a condition of employment.

I understand that this application is considered current for three months. If I wish to be considered for employment after this period I must fill out and submit a new application.

If employed, I will be required to provide original documents which verify my identity and right to work in the United States.

Signature:

Date:

Driver's License or ID Card #:

State where Issued:

By clicking "Agree and Submit Application" below I hereby acknowledge that I have read and agree to the above statements and that the information I have provided is true and correct.