Application For: ELECTRONICS ENGINEER, LEUVEN, BELGIUM


Thank you for considering applying for a position with our company. We appreciate the time you are giving to complete this application form. It is important that you fully and accurately complete this form yourself and that you indicate the position(s) for which you wish to be considered. Please be very accurate in your completion of this application. We use a sophisticated and detailed background and employment screening process which will disclose inaccurate, false, and/or incomplete or omitted information. You must complete every question on this application to be considered.

GENERAL INFORMATION

First Name *
Middle Name
 Last Name *
Have you ever used another name? Yes No   If yes, list all:
Address
 Address 2
 City
Country
 Postcode
  
Email
 Phone Number*
 alternate Phone Number
If hired, would you have a reliable means of transportation to and from work? Yes No
If you are under 18 years of age, can you provide proof of your eligibility to work? Yes No
If hired, can you provide proof of Belgian citizenship or proof of your legal right to work in Belgium? Yes No


EMPLOYMENT DESIRED

Position applied for:
How did you hear about this position?
Date available to start work:
Desired hours (P/T, F/T, etc):
Desired Salary:


EDUCATIONAL INFORMATION

School Name & Address of School Course of Study Years of
Study 		Diploma/Degree
High School
Undergradute College
Graduate/Professional
Other
Do you have any other experience, training, qualificaitons, or skills which you feel make you especially suited for work at our company?
List any computer programs with which you are familiar:


EMPLOYMENT HISTORY

Are you currently employed? Yes No
If yes, may we contact your present employer? Yes No
Please list your present and past employers starting with your most recent employer. Please account for all periods of unemployment. You must complete this section even if you are attaching a resume.
Employer #1 Position
Address City
Country Postcode
Start Date (mm/dd/yy) Starting Pay
End Date (mm/dd/yy) Ending Pay
Reason for Leaving
Contact Phone #
 
Employer #2 Position
Address City
Country Country
Start Date (mm/dd/yy) Starting Pay
End Date (mm/dd/yy) Ending Pay
Reason for Leaving
Contact Phone #
 
Employer #3 Position
Address City
Country Country
Start Date (mm/dd/yy) Starting Pay
End Date (mm/dd/yy) Ending Pay
Reason for Leaving
Contact Phone #
 
Employer #4 Position
Address City
Country Country
Start Date (mm/dd/yy) Starting Pay
End Date (mm/dd/yy) Ending Pay
Reason for Leaving
Contact Phone #
 
Please account for any time(s) you were not employed in the last 7 years, after leaving school. You don't have to include periods of one month or less. You must account for all periods of unemployment.


OTHER

Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation? Yes No
If no, describe the functions that cannot be performed:
Note: n.
H: Yes No
I:


 

Please read each statement closely and check each box acknowledging your understanding.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I

If offered a position with the Company, I hereby agree to any legally permitted physical, psychological, skill, drug, or medical test required by the Company as a condition of employment.

I

I understand and agree that the Company's acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application.
MY ANSWERS HAVE BEEN TRUE AND ACCURATE PURSUANT TO THE PENALTY UNDER THE LAWS OF BELGIUM. I HAVE READ AND UNDERSTAND THE ABOVE POLICY STATEMENTS AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THE COMPANY.