Application Preview Page Name* First Last Phone*Best time to contact you?* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Have you ever been employed with us before?* Yes No From* MM slash DD slash YYYY To* MM slash DD slash YYYY Department* Position Applying For* Location* Texas Vermont When can you start working?* Do any of your friends or relatives work here?*If yes, please state who and relation.Do you have reliable transportation?*This is a condition of employment. Yes (Personal) Yes (Public) No How did you hear about Champlain Cable?* Are you 18 or older?* Yes No Are you legally eligible for employment in the United States?*Proof of citizenship or immigration status will be required upon employment. Yes No What shift(s) are you willing to work?* Any 1st 2nd 3rd Have you ever worked in manufacturing?* Yes No Have you ever worked 2nd or 3rd shift?* Yes No Describe any specialized training or skills (machine operation, etc.)*EducationName and Location of High School* Did you graduate?* Yes No Have you attended Business/Trade/Technical school?* Yes No Name and Location of School* Course of Study* Number of Years Completed* Did you graduate?* Yes No Degree of Diploma* Have you attended College?* Yes No Name and Location of School* Course of Study* Number of Years Completed* Did you graduate?* Yes No Degree or Diploma* Have you served in the Military?* Yes No From* MM slash DD slash YYYY To* MM slash DD slash YYYY Branch of Service* Type of Discharge* Work ExperienceCompany* Type of Business* Phone*Address* Employed From (month & year)* Employed To (month & year)* Starting Weekly Pay Ending/Present Weekly Pay Name of Supervisor* Supervisor's Job Title* Job Title* Job Description*Reason for Leaving* May we contact?* Yes No Do you have more work history to add? Yes No Company Type of Business PhoneAddress Employed From (month & year) Employed To (month & year) Starting Weekly Pay Ending/Present Weekly Pay Name of Supervisor Supervisor's Job Title Job Title Job DescriptionReason for Leaving May we contact? Yes No Do you have more work history to add? Yes No Company Type of Business PhoneAddress Employed From (month & year) Employed To (month & year) Starting Weekly Pay Ending/Present Weekly Pay Name of Supervisor Supervisor's Job Title Job Title Job DescriptionReason for Leaving May we contact? Yes No Resume & Cover LetterResumeMax. file size: 50 MB.Cover LetterMax. file size: 50 MB.Applicants StatementI certify that answers given in this application are true and complete. I understand that any false answers or statements made by me on this application or during any interview will be sufficient grounds for immediate discharge. I voluntarily give Champlain Cable Corporation the right to make a thorough investigation of my past employment and educational activities and release from all liability all persons, companies or corporations supplying such information. I understand that acceptance of an offer of employment creates no obligation upon you, the employer, to continue to employ me in the future. I understand that Champlain Cable Corporation is under no obligation to supply a reason for not hiring an individual.Digital Signature*Please type your full name. Date* Δ
