UCCwireless 
On-line Employment Application

Please provide the following  information:

Position applied for  

Referral source            Advertisement            Employee        Relative        Other

            Name            
                                                Last, First, Middle Initial

           Address           
                                                                   
                                                        City, State, Zip  

   Social Security #          Email address  

      Home Phone                  Cell phone/ Pager/ Other  

____________________________________________________________________________________

If you are under 18, and it is required, can you furnish a work permit                Yes     No

If no, please explain 

Have you ever been employed by United Communications before?                   Yes      No
If yes, please give dates and positions

Are you legally eligible for employment in this country?                                      Yes      No

Date available for work                  What is your desired salary range? 

Type of employment desired    Full-Time        Part-time      Temporary    Seasonal

Are you able to meet the attendance requirements of the position?                     Yes       No

Have you ever pled "guilty" or "No Contest" to or been convicted of a crime?    Yes*     No

If yes, please provide date(s) and details
  

*answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

____________________________________________________________________________________

Please provide the following information for you past four (4) employers, assignments, or volunteer activities starting with the most recent.

 Date                                 Employer                                                Telephone #
to     

Starting job title                 Final Job Title                       Address
       
                                                                                

Immediate Supervisor title           Summarize the nature of work performed and job responsibilities
  

May we contact for reference?   Yes   No   Later

Reason for leaving?     

Salary  Start        Per                         Final                     Per
                 

___________________________________________________________________________________
     

Date                                 Employer                                                Telephone #
to      

 Starting job title                 Final Job Title                       Address
     
                                                                              

Immediate Supervisor title          Summarize the nature of work performed and job responsibilities
  

May we contact for reference?   Yes   No   Later

Reason for leaving?  

Salary  Start        Per                         Final                     Per
            

____________________________________________________________________________________

Date                                 Employer                                                Telephone #
to      

Starting job title                 Final Job Title                       Address
     
                                                                              

Immediate Supervisor title         Summarize the nature of work performed and job responsibilities
  

May we contact for reference?   Yes   No   Later

Reason for leaving?  

Salary  Start        Per                            Final                   Per
               

____________________________________________________________________________________

Date                                 Employer                                                Telephone #
to      

Starting job title                 Final Job Title                       Address
     
                                                                              

Immediate Supervisor title         Summarize the nature of work performed and job responsibilities
  

May we contact for reference?   Yes   No   Later

Reason for leaving?   

Salary  Start        Per                            Final                   Per
to         to

____________________________________________________________________________________