Job Application: Maintenance Technician – Boston

Title: Maintenance Technician – Boston

Fields marked with an asterisk (*) must be filled out before submitting.

PERSONAL INFORMATION

First Name *
Middle Name
Last Name *
Date of Application *
Address *
City *
State *
ZIP *
Primary Phone *
Secondary Phone
Email Address *
 

OCCUPATIONAL OBJECTIVES

Position Applied For: *
Salary/Wage Required: *
Shifts Available: * Day
Afternoon
Evening
Night
Weekends
Employment Status: * Full-Time
Part-Time
Per-Diem
Temporary
Start Date
What is your occupational goal?
 

ADDITIONAL QUESTIONS

Referral Source
Name of Referral
 
If you are under the age of 18, can you provide required proof of your eligibility to work? * Yes
No
 
Have you applied at MHPI, Inc. or RSSI, Inc. before? * Yes
No
– If yes, what position?
 
Were you interviewed? Yes
No
Date of Interview:
 
Have you ever been employed at MHPI, Inc. or RSSI, Inc. before? * Yes
no
Start Date:
End Date:
Campus/Job Title:
 
Do you have any scheduling limitations? Yes
No
– If yes, please explain:

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes
No
 
Skills/Qualifications/Licenses/Certifications
 

EDUCATIONAL BACKGROUND

High School

Name/Address of School *
Course of Study
Years Completed *
Diploma/Degree *
 

College

Name/Address of School
Course of Study
Years Completed
Diploma/Degree
 

Other

Name/Address of School
Course of Study
Years Completed
Diploma/Degree
 

EMPLOYMENT EXPERIENCE

[1] Employment History

Employer Name: *
Address: *
Job Title: *
Start Date – End Date: *
Starting Wage – Ending Wage:
Supervisor Name: *
Telephone No.: *
May We Contact for Reference? * Yes
No
Later
Summarize the nature of work performed and responsibilities.
 

[2] Employment History

Employer Name: *
Address: *
Job Title: *
Start Date – End Date: *
Starting Wage – Ending Wage: *
Supervisor Name: *
Telephone No.: *
May We Contact for Reference? * Yes
No
Later
Summarize the nature of work performed and responsibilities.
 

[3] Employment History

Employer Name:
Address:
Job Title:
Start Date – End Date:
Starting Wage – Ending Wage:
Supervisor Name:
Telephone No.:
May We Contact for Reference? Yes
No
Later
Summarize the nature of work responsibilities.
 

REFERENCES FOR EMPLOYMENT

I authorize MHPI, Inc. and/or its agents to conduct an investigation of my application for employment as considered necessary. I authorize and request any and all former employers and/or businesses referenced to furnish information concerning my past job performance and work histories. I release from any liability the individuals and businesses named below furnishing such information. I recognize a photocopy of this authorization is a valid requisition. I understand that any false statements on my application are grounds for dismissal or withdrawal of any offer of employment.

Name: *
Company Name: *
Telephone No.: *
Was this person your direct supervisor? *
 
Name: *
Title: *
Company Name: *
Address:
Telephone No.: *
Was this person your direct supervisor? *
 
Name:
Title:
Company Name:
Telephone No.:
Was this person your direct supervisor?
 

OTHER INFORMATION

Resume
Cover Letter
 

We consider applicants for all positions without regard to race, color, religion, creed, gender, sexual orientation, gender identification, national origin, age, disability, marital or veteran status, or any other legally protected status.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

I agree to conform to the rules and regulations of this company. I understand that my employment maybe terminated at any time for any reason at the option of either myself or the company. I hereby affirm the information on this application is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I further understand that a criminal background check may be part of the verification process and that all employment history information may be checked.

By typing my electronic signature below, I hereby acknowledge that I have read in full, understand and agree to the above statements and conditions of employment

First Name: *
Last Name:
Date: *
 

 

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