HOLADAY CIRCUITS, INC.

Application for Employment

DATE

NAME

ADDRESS 

PHONE

OTHER PHONE #

WHAT SHIFT ARE YOU APPLYING FOR?

1st Shift
2nd Shift
Weekend Shift
Full Time
Part Time

POSITION APPLIED FOR  

Are you available to work overtime?                 yes no                    

How were you referred to Holaday?  None Other Holaday Employee Employment News Star Tribune Job Service MN Job Bank Holaday Web Site  

WAGE DESIRED  

PREVIOUS EMPLOYMENT (List your most recent employers, starting with the MOST RECENT FIRST)

1)  COMPANY NAME

ADDRESS    

DATES  to

SUPERVISOR

POSITION 

RESPONSIBILITIES 

SALARY

REASON FOR LEAVING 

2)  COMPANY NAME

ADDRESS    

DATES  to

SUPERVISOR

POSITION 

RESPONSIBILITIES 

SALARY

REASON FOR LEAVING 

3)  COMPANY NAME

ADDRESS    

DATES  to

SUPERVISOR

POSITION 

RESPONSIBILITIES 

SALARY

REASON FOR LEAVING 

EDUCATION

HIGH SCHOOL

ADDRESS 

Did you graduate? yes no

Subjects Studied 

OTHER EDUCATION 

ADDRESS     

Did you graduate?  yes no

SUBJECTS STUDIED 

HAVE YOU applied at Holaday before? yes no

HAVE YOU ever worked at Holaday?  yes no If yes, when? 

Do you have any commitments or activities with another employer that might affect your employment with us?  yes no

IF HIRED, can you provide proof that you are at least 18 years of age?  yes no

If yes, please explain.

*An affirmative response will not automatically disqualify you from being considered as a candidate for employment.

Holaday Circuits, Inc. is committed to providing equal employment opportunity to all its employees and qualified applicants for employment. Various agencies of the government require employers to request employees and applicants to identify themselves as indicated below. The requested information will assist us in tracking employee statistics and evaluating our diversity recruiting efforts. This information is held in confidence and is used only in accordance with applicable Federal or State government reporting requirements.  COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS DECISIONS REGARDING YOUR APPLICATION.

Male     Female 

American Indian/Alaskan
Asian/Pacific Islander
Black
Hispanic
White                                                                                                                              Decline to state

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that any falsified information or omissions in any detail may disqualify me from further consideration for employment and may be considered justification for discharge if discovered at any time.

I hereby agree to submit to any lawful testing that may be required as a condition of my employment or continued employment and understand that refusal to submit to such testing during the course of my employment may result in disciplinary action, up to and including discharge.

I further agree, that if employed, I will confirm my conduct to Holaday’s rules and regulations. I understand that, unless otherwise specifically agreed to in writing by Holaday Circuits, Inc, my employment is terminable-at-will and may be terminated with or without cause, and with or without notice, at any time, at either Holaday’s or my own option. This application is not intended to be and does not constitute a contract for continued employment.

DATE       SIGNATURE