Url First Name * Last Name * Address * Email Address * Home Number * Cell Number * 18 years of age or older? * Yes No Position Applying for * Bucket Truck Operator Field Service Technician Tower Technician Technical Support Representative, Tier 1 Technical Support Representative, Tier 2 Operations Administrative Assistant Systems Engineer - Servers NOC Engineer, Tier 2 Inside Sales Representative Location * Champaign, IL Evansville, IN Lafayette, IN Muncie, IN Portland, IN Rushville, IN Fort Mitchell, KY Madisonville, KY Owensboro, KY Lima, OH Status * Full-time Part-Time Temporary Can you work: * Days Evenings Weekends Work overtime hours? * Yes No Reliable means of transportation to/from work? * Yes No Salary or Rate of Pay Desired? * Date available to start work? * Related to a current employee? * Yes No If Yes, who: Please List below three persons you have known for at least one year (exclude former employers and relatives). * Name and Occupation, Address and Phone Number High School Address1 Course of Study Did you Graduate? Yes No List Degree or Diploma College Address2 Course of Study 2 Did you Graduate? Yes No List Degree or Diploma Graduate School Address3 Course of Study 3 Did you Graduate? Yes No List Degree or Diploma Other Address4 Course of Study 4 Did you Graduate? Yes No List Degree or Diploma WORK HISTORY (LIST MOST RECENT EMPLOYER FIRST) Job Title Start Date dd-mm-yyyy End Date dd-mm-yyyy Employer Employer Address Employer Phone Number Supervisor's Name Supervisor's Phone Number Reason for Leaving quit layoff discharge Job Title Start Date dd-mm-yyyy End Date dd-mm-yyyy Employer Employer Address Employer Phone Number Supervisor's Name Supervisor's Phone Number Reason for Leaving quit layoff discharge Job Title Start Date dd-mm-yyyy End Date dd-mm-yyyy Employer Employer Address Employer Phone Number Supervisor's Name Supervisor's Phone Number Reason for Leaving quit layoff discharge Job Title Start Date dd-mm-yyyy End Date dd-mm-yyyy Employer Employer Address Employer Phone Number Supervisor's Name Supervisor's Phone Number Reason for Leaving quit layoff discharge Job Title Start Date dd-mm-yyyy End Date dd-mm-yyyy Employer Employer Address Employer Phone Number Supervisor's Name Supervisor's Phone Number Reason for Leaving quit layoff discharge Are you on lay off and subject to recall? Yes No Are you known to schools/references/employers by another name? Yes No If Yes, please indicate the name(s): Bound by any non-competitive, non-solicitation, and/or non-disclosure agreement with another person or entity? Yes No List any special skills or training we should be aware of in considering your employment: EEO-1 Voluntary Self Identification Form Gender Male Female Race/Ethnicity Hispanic or Latino White (Not Hispanic or Latino) Black or African American (Not Hispanic or Latino) Native Hawaiian or Pacific Islander (Not Hispanic or Latino) Asian (Not Hispanic or Latino) Native American or Alaska Native (Not Hispanic or Latino) Two or more races (Not Hispanic or Latino) I do not wish to disclose. APPLICANT STATEMENT I hereby certify that all responses set forth during my employment application process are true and complete. I understand and agree that any falsification, misrepresentation, or omission either on the employment application form or in my responses to questions asked during the interviewing or examination process may disqualify me from further consideration for employment, or if employed by W.A.T.C.H. TV Company d/b/a Watch Communications (“Company”), will subject me to immediate termination, whenever the falsification, misrepresentation, or omission is discovered. In this regard, where an item is left blank on the employment application, it is because there is no information within its scope. My signature authorizes the Company or its authorized agents to conduct a thorough investigation of all statements, written and oral, made by me during the employment application process, including without limitation, information concerning my employment positions, law enforcement record, driving record, and educational background. If a third party is utilized to conduct a background check, the Company will comply with the Fair Credit Reporting Act. I hereby authorize all persons, companies or other entities connected with any such informational request, including without limitation, current or prior employers and law enforcement agencies to provide any and all information they may have regarding me or my employment. I release and agree to indemnify the Company, its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of such investigation, including without limitation, any liability for furnishing information or for taking any action based on the information provided. I understand that a drug screen may be required before and during my employment. In addition, I authorize a medical examination, including a drug screen, by an examiner selected by the Company if I am made Page 3 of 3 a contingent offer of employment. I release and agree to indemnify the Company, its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of any medical examination or drug screen or for the taking of any action based on the results of any medical examination or drug screen. I agree and consent that the Company may inspect any of its property at any time and for any reason, without notice. This property includes, without limitation, work stations, computers, offices, desks, lockers, voice mail, and filing cabinets. Additionally, I agree and consent that any personal items I bring onto Company premises are subject to inspection at any time and for any reason, without prior notice. I can provide legally required documentation which shows that I have immediate authorization to work in the USA for any employer. If I fail to provide the required legal documentation within the required time period for Form I-9 completion, I will be terminated from my employment. I understand and agree if I am employed by the Company, my employment is at-will so that I may terminate my employment at any time and for any or no reason. Likewise, the Company can terminate my employment at any time and for any or no reason. I also understand and agree that nothing contained in the Company’s employment application or in the granting or conducting of an interview or anything set forth in any oral or written statement, communication, or policy now or in the future constitutes or creates or is intended to constitute or to create a contract or promise between me and the Company for employment, hours of work, compensation, or for the providing of benefits. Moreover, I acknowledge that the Company may modify, revoke, suspend, terminate, or change any or all of its plans, policies, or procedures at any time, without prior notice. No promises or guarantees regarding employment, hours of work, compensation, or for the providing of benefits have been made to me. I further understand and agree that no such promise or guarantee is binding on the Company unless it is confirmed in writing, signed by the President & Chief Executive Officer, and that document states that the employment relationship is not “at-will” and details the specific promise or guarantee. READ CAREFULLY BEFORE SIGNING. In consideration of the Company’s review of my application, I knowingly agree and understand that any claim or lawsuit arising out of my application for employment with, my employment with, or subsequent separation from the Company must be filed no more than 365 calendar days after the date the employment action that is the subject of the claim or lawsuit. While I understand that the statute of limitations for claims or actions arising out of an employment action may be longer than 365 calendar days, I agree to be bound by the 365 calendar day period of limitations set forth herein, and I waive any STATUTE OF LIMITATIONS TO THE CONTRARY. If this provision is held to be invalid or unenforceable, I agree that the time period will be increased to the minimum extend necessary to make this provision valid and enforceable. I have read and understand the contents of this employment application and am fully able and competent to complete it. I have read and understand the contents of this employment application and am fully able and competent to complete it. https://watchcomm.net/privacy-statement/ * Attach Resume Add Files
