+Electrical Assembly Technician

Darifill Employment Application

An Equal Opportunity Employer

DariFill is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify DariFill.

If you are providing us with a resume that contains information asked for below, you may mark those sections “see resume”. Email resume to hr@darifill.com
Applicant Information
First Name*
Last Name*
Home Phone*
Other Phone
Email*
Current Address*
(include city, state, and zip code)
How did you learn about this position?
Employment Position
Position(s) applying for*
Hours*
Select one
- Regular full-time
- Regular part-time
- Temporary / Intern / Co-op
What days and hours are you available to work?*
Can you work on the weekends if needed?*
- Yes
- No
Can you work evenings if needed?*
- Yes
- No
Can you available to work overtime if needed?*
- Yes
- No
Salary desired

Education, Training and Experience
High School
Name of High School
High School city, state
Number of years completed
Did you graduate?
- Yes
- No
College/ University
Name of College/ University
College/ University city, state
Number of years completed
Did you graduate?
- Yes
- No
Degree/ Diploma earned:
Vocational School
Name of Vocational School
Vocational School city, state
Number of years completed
Did you graduate?
- Yes
- No
Degree/ Diploma earned:
Military
Branch
Rank in Military
Total years of service
Skills/ Duties
Related details
Additional Information
Do you speak, write or understand any foreign languages?
- Yes
- No
If yes, describe which language(s) and how fluent of a speaker you consider yourself to be.
Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us? If yes, please explain

Employment History
Are you currently employed?*
- Yes
- No
If you are currently employed, may we contact your current employer?*
- Yes
- No
Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment.
Name of Employer
Name of Supervisor
Phone
Employer Address
Business Type
Dates of employment
From
To
Position & Duties
Reason for leaving
Name of Employer
Name of Supervisor
Phone
Employer Address
Business Type
Dates of employment
From
To
Position & Duties
Reason for leaving
Name of Employer
Name of Supervisor
Phone
Employer Address
Business Type
Dates of employment
From
To
Position & Duties
Reason for leaving

References
List below three persons who have knowledge of your work performance within the last five years. Please include professional references only.
Reference Name
Phone Number
Reference Email
Address
Employer
Occupation
Number of years acquainted
Reference Name
Phone Number
Reference Email
Address
Employer
Occupation
Number of years acquainted
Reference Name
Phone Number
Reference Email
Address
Employer
Occupation
Number of years acquainted

Factuality Agreement
Please read and initial each paragraph
I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true and correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure employment with DariFill can be grounds for rejection of the application or, if I am employed by DariFill, can be terms for my termination from DariFill.
Initials*
I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, by either me or DariFill.
Initials*
I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, by either me or DariFill.
Initials*
Applicant Signature
I agree to the terms and conditions
Date
MM
DD
YYYY

Darifill Employment Application