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Please fill out the below job application.  You will have the option to also submit a resume at the end of the form.
Fields marked with * are required.
 
Employment Eligibility
Do you have the legal right to obtain employment in the U.S.?    Yes  No
All employees upon being hired, must complete an Employment Eligibility Verification (Form I-9) as required by Title 8, U.S. Code Section 1324A.  Employees will be required to present appropriate documents to QEMS, Inc. for verification of legal right to work
 
Personal Information
Last Name
First Name
M.I.
Date
month day year
Have you ever used another name? (If yes, please explain)
Name you prefer to be called
Are you over 16 years of age? If under age must provide work permit.
Yes  No
*Current Mailing Address
Apartment / Unit #
*City
*State
*Zip Code
*Home Telephone
*Message Phone Number
*Email Address
*Resume Attached? Yes  No
*Permanent Forwarding Address
(If different from above)
   
Have you previously applied for work at QEMS, Inc.? Yes  No 
If yes, when? Reason of departure:
Have you previously been employed by QEMS, Inc.? Yes  No  If yes, dates from to
 
How were you referred to QEMS, Inc.?
Self  Advertisement  Employee Referral   Agency   
Other
 
Names of Relatives Employed at QEMS, Inc.
Relationship 
 
Type of position for which you are applying
     
Did you review QEMS website Yes  No
Date Available to Start
   
Type of Employment
(Please check appropriate box(es)

Full Time  Part Time  Temporary  Internship 
Summer
   
Please indicate shifts you are able to work 1st  2nd
   
Available for Overtime? Yes  No
 
Education/Training/Skills
Select last level of Education Completed for each of the Following:
Highschool 9  10  11  12  GED Diploma Yes 
Tradeschool 1   2   3   4  Diploma Yes 
College/University 1   2   3   4   Diploma Yes 
Post Graduate Education 1   2   3   Diploma Yes 
   
   
College/Grad School
Location (City & State)
Major
Degree Earned
   
Vocational And/or Professional Information(ie. Research projects, Thesis Subjects, Publications, Patents, Seminars, Volunteer Work). Do not list courses taken towards a degree or diploma.
 
List job-related skills not indicated below:
 
Check skills at which you have had actual experience in.
X
Electronic Assembly
Length of Experience
Electronic Component Color Code
Component ID
Blueprints/Schematics
Component Preparation
Hand Solder
IPC 610
IPC JSD 001
IPC 7711
Surface Mount Hand Solder
PCB Wiring Solder
 
Cables
  
Crimping
Harness Assembly
Connector/Wire Soldering
Cable Prepping
 
Testing
  
Oscilloscope
ICT Testing
Trouble Shooting
Component Testing
Logic Analyzer
 
Inspection
  
Bare Board
PCB Loaded
Systems
Components
Cable/Harness
Microscope
Measuring Tools (Michrometers, Calipers, Depth Gauges )
Machine Operations
  
Selective Wave Solder
Surface Mount Insertion Equipment
Wave Soldering
Mechanical & Electrical Tools
Power Air Guns
Taps & Dies
Alignment Tools
Measuring Tools
Office Skills
Typing Speed: WPM:
Telephone: System
Scanner:
Word Processor:
Data Entry
Ten Key
Spread Sheet (PC)
Warehouse
Forklift
Electronic Scales
Pallet Jack
Staple Gun
Cycle Counting
Kitting
   
Most Recent or Present Employer
Company Name
Phone
Employed
From
  To
Type of Business
Address
Starting Base Salary
Final Base Salary
Other Compensation
Date of Last Pay Increase 
Supervisor Name
Supervisor Title
Job Title
Reason you left or are considering leaving
May we contact? Yes  No
If "No", may we contact upon your acceptance of our employment offer? Yes  No
Your Duties
(please describe in detail)
 
   
Company Name
Phone
Employed
From
  To
Type of Business
Address
Starting Base Salary
Final Base Salary
Other Compensation
Date of Last Pay Increase 
Supervisor Name
Supervisor Title
Job Title
Reason you left or are considering leaving
May we contact? Yes  No
If "No", may we contact upon your acceptance of our employment offer? Yes  No
Your Duties
(please describe in detail)
References
Please list three persons best qualified to comment on your related experience and/or education background.
Include Supervisors not listed above. Do not include relatives.
 
1.
2.
3.
Name
Title
Company
Address
Business Phone
Security
Have you ever pled guilty, no contest or been convicted of a crime? (Do not include items that were sealed, readicated, erased, or expunged; convictions that resulted in referral to a diversion program. If "Yes" please explain - indicate charge, date of crime and conviction (a criminal history does not necessarily mean you will not be considered for employment)
  A "yes" answer will not necessarily disqualify your application.
If yes, give dates, places, charges & disposition
Closing Statement
I certify that all information furnished on this form is true, complete and correct to the best of my knowledge.
I authorize past and present employers, educational institutions and references to verify information on the application and release them to provide additional information relating to my past employment, education and performance as requested by QEMS, Inc. or its agents.
I authorize QEMS, Inc. or its agents to verify any such information and understand that falsification or omission of information on this application is grounds for termination of further consideration for employment and/or termination of employment.
I understand that QEMS, Inc. reserves the right to request a physical examination and drug testing. I understand that I will be required to submit to substance abuse screening on a pre-employment, for cause and random basis. Any offer given by QEMS, Inc. is contingent upon a negative drug screen.
I understand that overtime and shift changes may be required and are conditions of employment.
I am aware that my employment with the company is for an unspecified period and constitutes at will employment. As a result, I am free to resign at any time, for any reason or for no reason. Similarly, the company is free to conclude its employment relationship with me at any time, with or without cause.
   
Your Resume