AVI Systems, Inc.
Employment Application
Applicant Information
Full Name: / Date:Last / First / M.I.
Address:
Street Address / Apartment/Unit #
City / State / ZIP Code
Phone: / E-mail Address:
Date Available: / Desired Salary: / $
Position Applied for:
Are you a citizen of the United States?
(Double click selection for field options) / YES / NO / If no, are you authorized to work in the U.S.?
(Double click selection for field options) / YES / NO
Have you ever worked for this company?
(Double click selection for field options) / YES / NO / If so, when?
Education
High School: / Address:From: / To: / Did you graduate?
(Double click selection) / YES / NO / Degree:
College: / Address:
From: / To: / Did you graduate?
(Double click selection) / YES / NO / Degree:
Other: / Address:
From: / To: / Did you graduate?
(Double click selection) / YES / NO / Degree:
Training
Describe any specialized training, skills and extra-curricular activities below.
References
Please list three professional references.Full Name: / Relationship:
Company: / Phone:
Address:
Full Name: / Relationship:
Company: / Phone:
Address:
Full Name: / Relationship:
Company: / Phone:
Address:
Previous Employment
Company: / Phone:Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving:
May we contact your previous supervisor for a reference?
(Double click selection for field options) / YES / NO
Company: / Phone:
Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving:
May we contact your previous supervisor for a reference?
(Double click selection for field options) / YES / NO
Company: / Phone:
Address: / Supervisor:
Job Title: / Starting Salary: / $ / Ending Salary: / $
Responsibilities:
From: / To: / Reason for Leaving:
May we contact your previous supervisor for a reference?
(Double click selection for field options) / YES / NO
Military Service
Branch: / From: / To:Rank at Discharge: / Type of Discharge:
If other than honorable, explain:
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized Executive of this organization.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand, also, that I am required to abide by all rules and regulations of the employer.
Signature: / Date:
NOTE: A signature is required when sending in an Employee Application. Please sign and either fax or mail completed application to Human Resources at:
FAX: 952-949-6000
MAIL: AVI Systems
Attn: Human Resources
9675 W. 76th Street, Suite 200
Eden Prairie, MN 55344
Equal Employment Opportunity Information
Voluntary Survey
______
The following requested information is voluntary and confidential. It will be kept separately from your application and any subsequent personnel file. We collect this information for the sole purpose of creating and maintaining Equal Employment Opportunity and Affirmative Action records. We appreciate your cooperation with our EEO/AA efforts. (Print off and complete.)
______
Name:______Date: ______
Job Title Applied For:______
How did you hear about this position?
_____AVI Website _____AVI Employee _____Walk In _____Word of Mouth
_____Website, please be specific______
_____Newspaper or Publication, please specific______
_____Other, please specific______
Gender: _____Male _____Female
Race/Ethnic Identity Data:
_____America Indian or Alaskan Native _____Asian or Pacific Islander
_____African American (Black) _____Hispanic
_____Caucasian (White, not of Hispanic Origin) _____Other (please list)______
Veteran Status:
_____Veteran Era _____Other
_____Not applicable
Disabled:
Would you be declaring disabled status under the Rehabilitation Act or ADA? Yes or No ______
AVI Systems, Inc.
9675 W 76th Street, Suite 200
Eden Prairie, MN 55344
WE ARE AN EQUAL OPPORTUNITY EMPLOYER Page 1