Individuals seeking to be employed and assigned at a Verizon Wireless store must fulfill this form. To submit, interested individuals should introduce themselves to the site manager and personally hand over the completed form.Download
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Dear Applicant: Thank you for your interest in employment with Verizon. As part of our application process, we are providing an Employment Application for your completion. o Please use blue or black ink to complete the Employment Application. o Complete the entire application. All requested information requires a response. o Write “N/A” (or “Not Applicable” ) for requested information t hat does not apply to you. o Write “Information Unavailable” when you do not have the requested information and you are unable to obtain it. Provide the reason why the information is unav ailable. For example: If a former employer is no longer in business, you should provide as much information as possible, including the name of the company, department, titl e/work duties, last salary, dates employed, reason for leaving, and the supervi sor’s name. However, if you are unable to obtain the telephone number and address, you should write “Information Unavailable – company closed”. o Carefully read page 4 of the Em ployment Application regarding certain state laws before completing the Criminal Record portion of the application. Be sure the information you provide about prior convictions is accurate and complete. o Note: If you have entered a plea of guilty, you may have a record of conviction. Convictions include even seemingly minor viol ations, i.e., driving without a seatbelt or littering. You must also include instanc es when you paid a fine for a traffic and/or motor vehicle violation. Please review each page of the applic ation carefully. Failure to provide complete and accurate information on this application could make you ineligible for hire or be a cause for termination if you are hired. 1 Verizon Application - Applicant Guide 1. The Application - If you make a mistake, draw one line through th e mistake, write your correction, and then write your initials by the change. If a sect ion does not pertain to you, you may write N/A in that section. DO NOT use N/A if you simply do not k now/remember information. N/A is only used if a section does not apply to you. 2. Page 1 – Education section. Make sure to complete this se ction as requested. Include “course of study” (usually General) and GPA. If you do not remember your GPA, pr ovide your average grade, for example “B Average”. 3. Page 2 – Work Experience. Please be sure to complete this as requested. Start with your most recent employment status and include all requested information. If you attende d school during a time period, enter the dates you were in school, then enter “full time student”. Periods of unemployment should be handled the same way. If you worked for a company that has closed, enter name of co mpany, city and state, and enter “information unavailable - company closed” for phone number, supervisor, etc. If the job for which you are applying r equires a Commercial Driver’s Licens e (CDL) and you already have a CDL, list an additional five (5) years of employment [for a total of ten (10) years]. If you do not have a CDL or the job for which you are applying does not require a CDL, you may lis t additional work experience beyond the five (5) years [for a total of ten (10) years] if you believe it is relevant to the job for which you are applying. If you were not self-employed, enter N/A in this section. If you were not an employee of Verizon, check the “no” box and enter N/A in that section. If the position requires testing, please ask your test admi nistrator for assistance if you have any questions. THIS IS A VERY IMPORTANT PART OF YOUR APPLICATION. Getting all the information correct will insure that your information is reviewed in a timely manner. If your wo rk history does not fit on Page 2, please ask the test administrator for additional copies of that page. 4. Page 3 – If you have no military experience, ent er N/A in this section. If you have military experience, ask the test administrator for a military form. In the section that asks you to “Review the skills belo w to identify those you possess”, “L - Low” does not mean “none”. If you have no experience in any of these areas, leave it blank - do not check “L”. The last question asks if you have a security clea rance. Those applicants with a security clearance will kn ow if this question applies to them. Those who have a security clearance typically have military or federal government work history. 5. Page 4 – Criminal Record. Misdemeanors and felonies – list all since age 18. Be sure to read the entire section carefully, and include any required information (including docket numbers, dates, and the dispositions). If the docket number is not known, please contact the cour thouse and obtain the number from the Court Clerk. 6. Page 5 – List all violations of motor vehicle laws/ordinances (other than parking violations) of which you have been convicted or forfeited bond or collateral during the past 3 years. If you have been charged with a violation of motor vehicle laws/ordinances and you are awaiting a trial or other disposition, indicate the offense charged and the expected date of trial or other disposition. If you are applying for a job in California, Massachusetts or Rhode Island, see section on page 4 under “Criminal Record” for tr affic offenses which you do not need to disclose. You do not have to report any offenses for which you have been arrested or charged, but that did not result in a conviction. Please be certain to include the violation, t he date, and the disposition (e.g. “fine paid”, “reduced to non-moving violation”, etc.). 7. Page 6 – Be sure to read this page and then answer “yes” or “no” at the bottom. Sign and date in the lower left corner of the page, unless you re side in the state of Maryland. 8. Page 7 – If you do not want to provide the Gender and Race/E thnic Group information, you must so indicate at the top of the page by writing your initials on the line. Regardless if you elect to provide the information on this page, please be sure to still fill in the “Application Date” and “Social Security Number” boxes. The Race and Gender/Ethnic Group information is not used for hiring decisio ns; it is used to comply with Federal laws concerning Affirmative Action. Please either self-identify OR initia l this page, do not do both. If you choose to indicate Race/Ethnic Group, please select only one ca tegory for Race/Ethnic group information. 2 1 Employment Application 4/2007 Please note that by submitting this applicat ion, you may be considered for available pos itions in multiple Verizon Communications Companies unless otherwise specified by you. Veriz on Companies are Equal Opportunity Affirmativ e Action Employers. Unlawful discrimination because of age, color, citizenship status, disability, disabled veteran status, gender, marital status, national origin, race, religion, s exual orientation, Vietnam-era veteran status or any other characteristic protected by applicable law is prohibited. If you believe you have been discriminat ed against, you may notify the Equal Employment Opportunity Commission, the Federal Communications Commission, the Employment Standards Administration and/or other appropriate federal, state or local agencies. Please be careful when completing your Verizon Employment Application. Answer all questions on this application completely and accurately. Failure to provide completely accurate information could make you ineligible for hire or be a cause for terminatio n if you are hired. Verizon Communications, at its discretion, may consider your application for employment after this date. Name (Last, First, MI) Social Security Number Present Address (Number/Street, Apt./Floor #) City State Zip Telephone No. (day) Home Work Cell Telephone No. (evening) Home Work Cell Telephone No. (other) Email Address (optional) May we contact you at your current employer? Yes No Are you legally authorized to work in the United States? Are you under 18 years of age? Will you now or in t he future require sponsorship for employment visa status (ex: H-1B)? Yes No Yes No Yes No What are your salary expectations? Please indicate your work location / geographic preference: When will you be available to st art work? $ Primary choice (City & State) Secondary choice (City & State) per Hour Immediately Within two weeks of job offer Annual Two weeks or more from job offer Type of position sought: Indicate the type of position desired (if known): Management Associate Indicate job title: Full-Time Part-Time Temporary Summer Were you ever an employee of Verizon or an affiliate company (i.e., former Bell Atlantic or GTE, Verizon Wireless, Verizon Business, etc)? Yes No If yes: Name of Company Last Salary Job Title Supervisor Supervisor’s Location (city/state) Dates Employed From (mm/yy) – To (mm/yy) - Reason for Leaving EDUCATION Name of High School City State Course of Study GPA/scale Did you graduate? Yes No Highest grade completed 9 10 11 12 GED (City/State of Testing Center) GED Agency Name Name of Under graduate Colle ge/Universit y or Trade School City State Course of Study/Degree GPA/scale Did y ou graduate? Type of diploma/certificate Yes No Dates Attended Years completed Credits Completed From To 1 2 3 4 Name of Under graduate Colle ge/Universit y or Trade School City State Course of Study/Degree GPA/scale Did you graduate? Type of diploma/certificate Yes No Dates Attended Years completed Credits Completed From To 1 2 3 4 Name of Graduate Colle ge/Universit y or Trade School City State Course of Study/Degree GPA/scale Did you graduate? Type of diploma/certificate Yes No Dates Attended Years completed Credits Completed From To 1 2 3 4 2 Name Social Security Number WORK EXPERIENCE List all employers for the past five (5) years, including cooperative and summer work. You may also list volunteer work. If unemployed during the 5-year period, list dates of unemployment. If self-employed, list dates and include clients that may be contacted for verifica tion (space is provided at the end of this section). The entire five (5) year period must be accounted for. In addition, you may indicate if information on your work experience is available under a different name (this w ill facilitate verification of your answer). If the job for which you are applying requires a Commercial Driver’s License (CDL) and you already have a CDL, list an additional five (5) years of employment [for a total of ten (10) years]. If you do not have a CDL or the job for which you are applying does not require a CDL, you may list additional work experience beyond the five (5) years [for a total of ten (10) years] if you believe it is relevant to the job for which you are a pplying. LIST MOST RECENT JOB FIRST Name of Company Address ( number/street/city/state/zip) Supervisor name and phone number Title/work duties Dates employed (From/To) Last salary Reason for leaving Name of Com pany Address (number/street/cit y/state/zi p) Supervisor name and phone number Title/work duties Dates employed (From/To) Last salary Reason for leaving Name of Com pany Address (number/street/cit y/state/zi p) Supervisor name and phone number Title/work duties Dates employed (From/To) Last salary Reason for leaving Name of Com pany Address (number/street/cit y/state/zi p) Supervisor name and phone number Title/work duties Dates employed (From/To) Last salary Reason for leaving Name of Com pany Address (number/street/cit y/state/zi p) Supervisor name and phone number Title/work duties Dates employed (From/To) Last salary Reason for leaving Name of Com pany Address (number/street/cit y/state/zi p) Supervisor name and phone number Title/work duties Dates employed (From/To) Last salary Reason for leaving Name of Com pany Address (number/street/cit y/state/zi p) Supervisor name and phone number Title/work duties Dates employed (From/To) Last salary Reason for leaving If you are currently employed, may we contact your employer and/or supervi sor to conduct a reference check? Yes No If yes: Please list name and phone number of individual to be contacted. If self-employed, list client reference and telephone number. Client(s) Dates (From/To) Telephone Number - - - - 3 Name Social Security Number U.S. MILITARY SERVICE/EXPERIENCE (DO NOT INCLUDE ROTC) Date of Discharge (mm/ dd/yy) Branch of Service Occupational Specialization Grade/Rank at Discharge Special/Technical Training Special/Technical Training Dates of Attendance (From/To) Type of Discharge (honorable, general, other than honorable) M i l i t a r y Occupational Skill (MOS) Long Title Are you fluent in a language other than English? (answering this question is optional) Review the skills below to identify only those you possess. For those skills you po ssess, check the corresponding block to indicate your proficiency for that particular skill. L - Low M - Medium H - High L M H L M H L M H Building Maintenance CAD Cable TV/CATV Installation Customer Service Data Input Electrical / Electricity Electronics Equipment Calibration Heavy Equipment Operator Keyboard (Windows environment) Mechanical PC Literacy Pole Climbing Presentation Skills Project Management Sales Software Engineering Skills Team Building Vehicle Maintenance Word Processing Other Indicate below any License(s) or Certificate(s) you possess. If you have a license/certificate that is not listed, mark the sq uare for “Other” and print the name of License/Certificate in the space provided. ASE Certification in Refrigerant Recovery Boiler Fireman’s License Certified Compensation Professional Certified Contract Manager Certified Management Accountant Certified Private Fleet Manager Certified Public Accountant Certified Purchasing Manager Certified Quality Engineer Certified Reliability Engineer Commercial Driver’s License Data Certification DC Engineer’s License Class 3 DC Engineer’s License Class 6 & 8a Facility Management Associate Forklift Certification High Pressure Steam License IT Certification (type) Master Electrician Nortel Certification Professional Engineer Project Management Certification Radio License (type) Worker’s Compensation Representative Refrigeration License/Heating, Air Conditioning, Licensed Smog Check Mechanic Micro-station Computer Aided Ventilation License Drawing Certificate SPHR or PHR (Professiona l in Human Resources) Other Verizon Communications does not permit empl oyees to work in organizations or functions that are directly or indirectly managed or supervised by relatives, members of their household, or persons with whom they have a close personal re lationship. Do any of your relatives, members of your household, or persons with whom you have a close personal relationship work for Verizon? Yes No If yes, provide name, relationship and work location Have you previously applied for a job with Verizon (or the fo rmer Bell Atlantic or GTE or any of their subsidiaries)? Yes No If yes: Date Name of Company City/State For positions that require a security clearance: Do you hold a security clearance? Yes No Type of clearance 4 Name Social Security Number CRIMINAL RECORD If you are applying for a job in Hawaii : DO NOT COMPLETE THIS PAGE UNTIL REQUESTED TO DO SO. If you are applying for a job in California: You are not required by California to pr ovide information concerning: * An arrest or detention that did not result in conviction. (However, you are required to provide information concerning an ar rest for which you are out on bail or on your own recognizance pending trial); * A referral to, and participation in, any pre-trial or post-trial diversion program; * Convictions for the following marijuana-related offenses that are more than two years old: (i) the misdemeanor possession of marijuana (other than concentrated cannabis); (ii) giving away, offering to give away, transporting, offering to transport, or attempting to transport not more than 28.5 grams of marijuana (other than concentrat ed cannabis); (iii) possessing paraphernalia used to inject or smoke marijuana; (iv) being present in a place where marijuana is used; (v) using or being under the influence of marijuana; * Convictions for which the record has been judicially ordered sealed, expunged, or statutorily eradicated; * Misdemeanor convictions for wh ich (i) probation has been successfully completed (o r otherwise discharged) and (ii) the case has been judicially dismissed; * Any arrest for which a pre-trial divers ion program has been successfully completed; Reporting of any of the above information prior to employment is strictly voluntary for California applicants and non-disclosure of this information will not be considered in the employment process. If you are applying for a job in Massachusetts : You must answer “No” if your criminal record consists only of one or more of the following: (a) misdemeanors in which the convictions occurred or the completion of any period(s) of incarceration resulting therefrom (if later) occurred five or more years ago (b) misdemeanor convictions li mited to a first offense for drunkenness, simple assault, speeding, minor traffic violations, disturbance of the peace or affray (c) minor traffic violations other t han reckless driving, driving to endanger and motor vehicle homicide and (d) if a charge was continued without a finding. An applicant for employment with a sealed record on file with the commissioner of probation may a nswer “no record” with respect to any inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, any appl icant for employment may answer “no record” with respect to any inquiry relative to prio r arrests, court appearances or adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint trans ferred to the superior court for criminal prosecution. If you are applying for a job in Rhode Island : You may answer “No” if your criminal record consists only of plea(s) of “no contest” or “nolo contendere,” you received only probation and served t he entire probation without any violation. All applicants: Read the application carefully and be sure that the information you provide about prior convictions is complete, true and includes even seemingly minor violations. The fact that you may have a record of convictions will not necessarily bar you from employment . Unless specified differently above, “Conviction” includes a plea of guilty, “no contest” or “nolo contendere.” If you have been charged with a crime and you are awaiting trial or other disposition, answer “yes.” If you were charged with a crime, but the charges were dropped, answer “no.” Traffic offenses are addressed in separate questions of the application. You may answer “no” to any convictions that were expunged. Have you ever been convicted of, or are you awaiting trial disposition on a Felony, Misdemeanor or Summary Offense? Yes No Are you currently on pretrial probation or conditional discharge or in an alternative rehabilitative program where you will be subject to trial if you do not successfully complete the probation or alternative rehabilitative program? Yes No If you answered “Yes” to either of the questions above, provide the following information: Nature of Offense City/County/State Docket No. (i.e. Cause/Case No. as appropriate) Conviction Date Probation End Date (if applicable) Sentence (If awaiting trial/disposition, or completion of pretrial probation or alternative rehabilitative program, give expected trial/disposition or completion of probation/program.) 5 Name Social Security Number DRIVER’S LICENSE & DRIVING RECORD All Applicants must complete this section List ALL VIOLATIONS of motor vehicle laws/ordinances (OTHER THAN PARKING VIOLATIONS) of which you have been convicted or forfeited bond or collateral during the past 3 years. Unless specified differently on the proceeding page “Conviction” includes a plea of “guilty,” “no contest” or “nolo contendere.” Your driving record will be che cked if you are applying for a driving position. Any false statement or failure to disclose requested information will result in refusal of employ ment or, if employed, termination from employment. If you have been charged with a violation of motor vehicle laws/ordinances other than parking violations and you are awaiting a trial or other disposition, indicate the off ense charged and the expected date of trial or other disposition, except as noted below. If you are applying for a job in California, Massachusetts or Rhode Island, see section on preceding page under Criminal Records for traffic offenses which you do not need to disclose. You do not have to report any offenses for which y ou have been arrested or charged, but that did not result in a con viction. List all violations of motor vehicle laws/ordinanc es for which you have attended Traffic School where the charge has not been removed fr om your driving record. If you are unsure , you should list the violation. List all Violations here (If you have no violations, state “none” in box 1) 1 mm/yyyy 4 mm/yyyy 2 mm/yyyy 5 mm/yyyy 3 mm/yyyy 6 mm/yyyy List any accidents within the past 3 years. Specify the date and nature of the accident (head-on, rear-end, etc.) and any fatalities or personal injuries caused. List by date of occurrence starting with the most recent. Do you hold a valid driver’s license? License Numbe r Issuin g State Yes No Have you ever held a commercial driver’s license? License Number(s) Issuing State Yes No Within the past 3 years, have you held a commercial driving position? Yes No Indicate the nature/extent of your experi ence in the operation of motor vehicles, including class and type of equipment (i.e., vans, buses, trucks, truck tractors, semi- trailers, full trailers and pole trailers). Include the length of time (start and end date) for each type of equipment. Have you held a driver’s license in any other State during the past 3 years? Yes No License Number Issuing State Have you ever had a license, permit or privilege to operate a motor vehicle denied, revoked or suspended? Yes No List all Suspensions here (If you have no suspensions, state “none” in box 1) 1 mm/yyyy 4 mm/yyyy 2 mm/yyyy 5 mm/yyyy 3 mm/yyyy 6 mm/yyyy 6 Name Social Security Number UNDERSTANDING AND AGREEMENT This application, any handbooks, policies, pr actices, procedures and other communications do not individually or collectively constitute a contract of employment or a guarantee of employment for any specific term . Subject to any applicable collective bargaining agreement or ap plicable law, (a) my employment is “at will,” which means that any offer of employ ment if made to me, or employment of me can be terminated at an y time by my employer or by me with or without cause or prior notice, (b ) compensation, benefits, policies, practices, procedures and terms and conditions of employment, with the exception of my “at will” status, may be chan ged or eliminated by my employer at any time without notice, and (c) I will comply with the rules and regulations of my employer, if I am hired. This paragraph supersedes any and all prior representations (exp ress or implied) to the contrary with respect to the grounds for which, and the manner by which, my employment with Verizon can be terminated. Verizon Companies or their agents may conduct investigations, including, but not limited to, those relating to prior employment history, record or conviction, pending trial status, and driving re cord, as permitted by law. An investigative consumer report including informat ion as to my character and personal characteristics may be made and I have the right to request (in writing) whether a report is sought, the name and address of the investigating consumer reporting agency and a complete and accurate disclosure of the nature and scope of the investigation. If a Consumer Reporting Agency is engaged in this investigation, information re levant to the nature and scope of the inquiry, if one is made, will be provided to me if adverse action concerning my employment is taken based, wholly or in part, on this investigation. Information that I have p rovided on this application, on my resume, or any other document provided to Ve rizon Communications as part of the application process is true and correct. By signing this application below, I authorize Verizon Communications Companies and their agents to conduct this investigation and I indicate my awareness that any false or misleading statement or failure to disclose requested information may result in refusal of employment or, in the event I am employed, may result in my immediate dismissal. If an offer of employment is made to me, it is conditioned on: (a) the satisfactory completion of a medical evaluation (when required by the job opening) conducted by a clinic approved by Verizon; (b) my ab ility to produce documentation establishing both my identity and e mployment authorization as required by law, and my completion of the employ ment verification form designated by the Immigration and Naturalization Service; (c) the results of a urinalysis screening for both legal and illegal drugs; (d) my successful completion of any other requirements mandated under federal, state or local laws; and (e) my meeting the minimum age requirement of applicable law. If I am employed, I will protect private or proprietary information owned or controlled by Veriz on. If required, as a condition of my employment, I will sign the “Employment Agreement Regarding Intellectual Property and Proprietary Information” which assigns to the Company certai n inventions, discoveries, improvements, ideas, computer or other apparatus, programs of work of authorship. If I have signed any agreements with any previous and/or current employers, relating to intellectual property (s uch as confidentiality proprietary rights, non-compete agreements, non-solicitation of customers agreements, etc.) I will provide a copy of any such agreements with this application. I warrant and represent that copies of any such agreements are provided with this application for employment. To the extent I do not have copies of such agreement(s), I have submitted with this application a written statement that describes the terms of such agreement(s). In the event I am employed, my eligibility for a pension will be based on the requirements set forth in the applicable pension plan if any, the provisions of which will be described in a summary plan de scription to be supplied to me following my employment. No oral representation of any Company employee or agent can alter any of the above five paragraphs. If hired, I understand and acknowledge that my employer will be t he individual and specific Verizon operating company, affiliate subsidiary, or successor company to which I report on a regular basis as a full or part-time employee. This application will remain in effect during my term of employment with Verizon and any of its operating compani es, affiliates, subsidiaries or successor companies. Have you ever been employed by a firm that performed Public Service Commission mandated audits of New York Telephone, NYNEX, or any other NYNEX subsidiary or by any subsidiary or aff iliate which performed any such audit? Yes No (if yes, please explain) This certifies that this application was completed by me, and that all entries are true and complete to the best of my knowledge. Under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment, or continued employment, that an individual submit to or take a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100. Signature of Applicant Date Signature of Applicant Date Application Date (mm/dd/yyyy) Social Security Number 7 VOLUNTARY SELF-ID Verizon, as a federal contractor, is required to maintain s pecific information on applicants for governmental reporting purpose s. Any information provided is confidential and will be used for the Company’s Affirmat ive Action efforts. The submission of this information is voluntary and will not subject you to any adverse treatment. However, if you choose not to “self-identify,” we are required under Federal law to maintain race and gender information on the basis of visual observa tion and personal knowledge. If you do not wish to furnish this information, please initial below. I do not wish to furnish this information. (Initials) Gender: Race/Ethnic Group (see definitions below): Male White Female Black or African American Hispanic or Latino Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Two or More Races Unknown White (Not Hispanic or Latino) - A person having origins in any of the original peopl es of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central Amer ican, or other Spanish culture or origin regardless of race. Asian (Not Hispanic or Latino) - A person having origins in any of the peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam . American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above six races.