Last Name: / First: / M.I.: / Date:
Street Address:
City: / State: / ZIP:
Home Phone: / Cellular Phone: / E-mail Address:
Date Available: / Social Security No: / Desired Rate of Pay:
Position Applying For:
Have you ever worked for Tower Systems, Inc. or Tower Systems South, Inc. before? o Yes o No / If so, when?
Are you a citizen of the United States? o Yes o No / If no, are you authorized to work in the United States? o Yes o No
Have you ever been convicted of a felony? o Yes o No / If yes, please explain:
EDUCATION
High School: / City/State:
From: To: / Did you graduate? o Yes o No / Degree:
College: / City/State:
From: To: / Did you graduate? o Yes o No / Degree:
Other: / City/State:
From: To: / Did you graduate? o Yes o No / Degree:
CERTIFICATIONS / TRAINING (please check all that apply)
o First Aid / CPR / o Competent Climber / o Andrew WP & Connectors / o Boom Truck Operator
o OSHA 10 hr Safety Course / o Competent Rescuer / o Anritsu Site Master / o Winch Operator
o OSHA 30 hr Safety Course / o Eupen Cable & Connectors / o Alcatel-Lucent Certified / o Crane Operator
o Other:
o Other:
PREVIOUS EMPLOYMENT
Company: / Phone: ( )
Address: / Supervisor:
Job Title: / Starting rate of pay: / Ending rate of pay:
Responsibilities:
Dates of employment: / Reason for leaving:
May we contact your previous employer for a reference? o Yes o No
Company: / Phone: ( )
Address: / Supervisor:
Job Title: / Starting rate of pay: / Ending rate of pay:
Responsibilities:
Dates of employment: / Reason for leaving:
May we contact your previous employer for a reference? o Yes o No
Company: / Phone: ( )
Address: / Supervisor:
Job Title: / Starting rate of pay: / Ending rate of pay:
Responsibilities:
Dates of employment: / Reason for leaving:
May we contact your previous employer for a reference? o Yes o No
PROFESSIONAL REFERENCES
Name: / Company: / Contact Number:
Name: / Company: / Contact Number:
Name: / Company: / Contact Number:
Name: / Company: / Contact Number:
SKILL LEVEL (please check all that apply)
N/A / Minimal Knowledge / Moderate Knowledge / Advanced Knowledge
Guy Tower Installation / o / o / o / o
Self Support Tower Installation / o / o / o / o
Monopole Installation / o / o / o / o
Antenna / Line Installation / o / o / o / o
Microwave Dish Installation / o / o / o / o
Path Alignment / o / o / o / o
Tower Rigging / o / o / o / o
Sweeping Lines / o / o / o / o
Foundation Installation / o / o / o / o
Site Surveying With Transit / o / o / o / o
Blue Print Reading / o / o / o / o
Gin Pole Operation / o / o / o / o
Computer Skills / o / o / o / o
ADDITIONAL QUALIFICATIONS
State any additional information that you feel may be helpful to us in considering your application:
MOTOR VEHICLE INFORMATION
Do you have a valid driver’s license? / If yes, what state is it issued in?
Do you have a clean driving record? / If no, please explain:
Do you have a CDL? / Do you have a medical certificate? o Yes o No
PASSPORT INFORMATION
Do you have a valid United States Passport? / If not, are you eligible to obtain one? o Yes o No
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 with Tower Systems, Inc. or Tower Systems South, Inc. I understand that false or misleading information in my application or interview may result in my release.
Applicant Signature: / Date:
FOR PERSONNEL DEPARTMENT USE ONLY
Arrange Interview o Yes o No / Remarks:
Employed o Yes o No / Date of Employment: / Job Title: / Rate of Pay:
Approved By: / Title: / Date:
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