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APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer


All applicants are considered without regard to race, color, gender, religion, national origin, age,
marital or veteran status, mental or physical disability unrelated to job performance or any other
legally protected status.

PERSONAL INFORMATION
______________________________________________________________________________________

Legal name: First

Last

Middle Initial

______________________________________________________________________________________

Address:

Street

City

State

Zip code

Home Telephone: _________________________ Other Telephone: __________________________


E-mail: ___________________________________ Social Security #: __________________________
Do you have a Valid Drivers License in good standing?

Yes

No

Drivers License #: ___________________________________ State: __________________________


Are you legally eligible for employment in the United States?
What is your current status?

__ US Citizen,

Have you been convicted of a felony?

Yes

No

__ Alien Resident

Yes

No

If yes, please explain circumstances: ____________________________________________________


_____________________________________________________________________________________

Are you at least 18 years old?

Yes

No

Date of Birth: _____________________

POSITION INFORMATION
Position(s) applying for: _________________________________ Salary desired: $_______________
Location(s) applying for: _______________________ Are you willing to relocate?
Employment status desired:

Full Time

Part Time

Yes No

Seasonal

What hours are you available to work? _________________________________________________


Can you work Weekends?
If hired, when could you start? __________________________________________________________
How did you hear about this job? ________________________________________________________

EMPLOYMENT HISTORY (Most recent first)


Duties:

1. Job Title:
Employer:
Dates of Employment (month / year)
From:
To:
Starting Salary:

Ending Salary:

Full Time Part Time Temp

Employers Address:
Supervisor:

May we contact? Yes No

Phone:

Reason for Leaving:


Duties:

2. Job Title:
Employer:
Dates of Employment (month / year)
From:
To:
Starting Salary:

Ending Salary:

Full Time Part Time Temp

Employers Address:
Supervisor:

May we contact? Yes No

Phone:

Reason for Leaving:


Duties:

3. Job Title:
Employer:
Dates of Employment (month / year)
From:
To:
Starting Salary:

Ending Salary:

Full Time Part Time Temp

Employers Address:
Supervisor:

May we contact? Yes No

Phone:

Reason for Leaving:


Duties:

4. Job Title:
Employer:
Dates of Employment (month / year)
From:
To:
Starting Salary:

Ending Salary:

Full Time Part Time Temp

Employers Address:
Supervisor:

Reason for Leaving:

May we contact? Yes No

Phone:

EDUCATION
Type of
school

Dates
Attended

Name and Location

Degree
Received

Subjects
Studied

Did you
graduate?

High School
College /
University
Graduate
School
Tech School
Other

Special courses, training or experience acquired, including military experience: ________________


______________________________________________________________________________________
______________________________________________________________________________________

SKILLS AND ABILITIES


In the table below, please place a check in the box closely describing your skill level in
the following applications/Operations. Please note that (5) indicates a High skill level
and (1) indicates a Low skill level.

Rating

Low

Below
Average

Average

Above
Average

Excellent

Internet Navigation:
MS. Windows XP
MS. Outlook
MS. Word
MS. Excel
MS. Power Point
MS. Internet Explorer
E-mail (send/receive)
Clipboard Ops. (copy, past, etc.)

Besides English, what other languages do you speak? __________________________________

Do you have experience selling any of the following products? Check all that apply:

__metroPCS

__T-Mobile

__Cingular

__Nextel

__Sprint PCS

__Verizon Wireless

__Other _______________________________

Please describe any other experience, abilities or skills that might be helpful in considering
your application:
__________________________________________________________________________________

CERTIFICATION & AUTHORIZATION

I hereby certify that all statements made in this application are true and correct to the best of my
knowledge and belief. I understand that any misrepresentations or omissions of facts in this
application are grounds for disqualification from further consideration or for dismissal from
employment.
Initials:______

I authorize XO Wireless llc to inquire into my educational, professional and past


employment history references as needed to research my qualifications for this position. I also
authorize XO

Wireless llc to conduct any necessary background checks.


Initials:______

If employed, I agree to conform to the rules, regulations and policies of the company. I
understand that I will be an employee at will and XO Wireless llc may terminate my
employment relationship at any time for any reason not in violation of law.

Initials:______

I hereby acknowledge that I have read and fully understand the forgoing and seek employment
under these conditions.

Initials:______

_____________________________________________

____________________

Signature of Applicant

Date