APPLICANT'S NAME

DATE

EMPLOYMENT APPLICATION

Morcom, N.V., Inc. considers applicants for all positions without regard to race, color, religion, sex, ancestry, national origin, age, marital or veteran status, arrest records, medical conditions, physical or mental disability, or any other legally protected status.

GENERAL INFORMATION
Please fill out our Application Form on screen and submit by clicking “Submit Application”. To those who need more pages for employment experience, please use “Reset” following “Submit Application” as many times as needed. In addition, each applicant must submit resume, in confidence to Morcom, N.V., Inc. 449 E. 31ST Street, Chicago, IL 60616 via US Mail or Fax No. 312-842-3101 and or send via email: tony@morcomnv.com via PDF format.

PLEASE TYPE YOUR ANSWERS TO THE FOLLOWING PAGES OF QUESTIONS.
 Last Name:
First Name:
Middle Name:
Home Address:
City:  State: Zip Code:
Home Telephone No.:
Position Desired:
Annual Salary Expectations:
Date Available for Employment:
 Referral Source (agency/newspaper/person/other):
ANY OFFER OF EMPLOYMENT WILL BE SUBJECT TO COMPLIANCE WITH THE IDENTIFICATION REQUIREMENTS IMPOSED BY THE IMMIGRATION AND NATURALIZATION SERVICES.
Professional License?  Yes    No
License Type: State(s):
Registration No(s):
Have you ever been convicted of a crime other than a traffic violation? Yes    No
If yes, provide details
  EDUCATION,SKILLS AND TRAINING
Name & Location Highest Year Completed Major, Degree or Certificate Length of Time Attended

 

Grade Point Average

(Actual/Total Possible)

Graduate?

 

High School

9 10 11 12

Yes    No

 

College

1 2 3 4 5

Major, Degree or Certificate Length of Time Attended Yes    No
Graduate School

1 2 3 4 5

Major, Degree or Certificate Length of Time Attended Yes    No
Technical, Trade or Other

1 2 3 4 5

Major, Degree or Certificate Length of Time Attended Yes    No

 

Scholarships, Awards and Honors Conferred:
Future Educational Plans:
List computer programs with which you are familiar and rate your proficiency (1-4; 4=highest):

Typing Speed:
In this space list any experiences, special skills, abilities or other pertinent information not included elsewhere on this application, such as projects, patents, languages, thesis subjects, publications, seminars/continuing education, etc., which you believe might aid us in evaluating your suitability for the position for which you are applying:

EMPLOYMENT RECORD
Begin with last or current employer. List all jobs held in the past ten years, in date order, including self-employment and unemployment. Service with the United States military should also be included, and, where asked to provide the reason for leaving the military, applicants are only to provide us with information as to whether or not their discharge was dishonorable. Finally, if you have ever been employed under a different name, maiden or other, please indicate this.
Employment Record 1
Name of Employer
Address
Phone number        
From    

To  

Starting Salary  Finishing Salary
Position(s)
Supervisor's Name
Responsibilities

Reason for Leaving:
May We Contact? Yes    No
Employment Record 2
Name of Employer
Address
Phone number        
From    

To  

Starting Salary  Finishing Salary
Position(s)
Supervisor's Name
Responsibilities

Reason for Leaving:
May We Contact? Yes    No
Employment Record 3
Name of Employer
Address
Phone number        
From    

To  

Starting Salary  Finishing Salary
Position(s)
Supervisor's Name
Responsibilities

Reason for Leaving:
May We Contact? Yes    No
Employment Record 4
Name of Employer
Address
Phone number        
From    

To  

Starting Salary  Finishing Salary
Position(s)
Supervisor's Name
Responsibilities

Reason for Leaving:
May We Contact? Yes    No
Professional References (Name two, with addresses and length of relationship):

Personal References: (Name two, with addresses and length of relationship):

TO THE APPLICANT - PLEASE READ AND SIGN:

I certify that the answers given herein are true and complete to the best of my knowledge, and I authorize the investigation of all statements contained within this employment application, as well as those made during any interview(s) which may be necessary in arriving at an employment decision. I further understand that in the event of my employment by the company, any false or misleading information given in my application or interview(s) may result in discharge. I also understand that as an employee of the company, I am required to abide by all Company rules and regulations.
I hereby authorize all schools and colleges I have attended, and my former employers to give any information regarding me they may have, including my performance with them. I authorize the military service branch(es) to provide appropriate information as to the status of my discharge from that organization. I also release the aforementioned schools, colleges, employers and the military service from any liability or damage whatsoever for issuing this information. I understand such information may include a record of disciplinary action assessed by a previous employer(s) and hereby release such party or parties from any obligation to provide me with written notification of such disclosure. I also release MORCOM, N.V., INC. and its employees from any liability or damage whatsoever for receiving and/or using this information in any investigation of the statements contained in the application and/or interview(s).
I understand that this application for employment shall be considered active for a period of time not to exceed 45 days, and that if I wish to be considered for employment beyond this time period, I should inquire as to whether or not applications are being accepted at that time.
I understand that any employment offer which may be extended to me by the company is contingent upon my ability to satisfy the physical and/or mental requirements for the position offered, which may require me to submit to a drug/alcohol screening test and a physical examination.
I understand that this application and/or offer of employment which I may receive from MORCOM, N.V., INC. does not, and is not intended to, create a contract of employment or any contractual right in favor of the company or me beyond those existing in an "at will" employment relationship. I understand that any employment relationship which may arise between the Company and me will be an "at will relationship", which means that the company reserves the right to terminate my employment at any time, with or without reason and with or without notice, and that I likewise have the right to terminate my employment with the company, at any time, with or without reason and with or without notice. I further understand that no representative of the company other than the Vice President, Senior Vice President, or President, has any authority to enter into any agreement for employment for any specified time, or to make any agreement contrary to the foregoing, and any such general or specific commitments must be in writing, in a document executed by both the Vice President, Senior Vice President, Executive Vice President, or President, and myself.

 

Signature of Applicant

You agree that submitting this form will be accepted as your digital signature.

Date