Employment Application

Pinnacle Data Systems, Inc. is an equal opportunity employer. Please fill in all applicable fields. Incomplete applications will not be considered for employment.

Personal Information
Date:
First Name:
Middle Initial:
Last Name:
Address
City:
State:
Zip:
Social Security Number:
Home Phone with area code:
Other Daytime phone with area code:
E-mail Address:
Are you 18 years or older?
Are you legally eligible for work in the United States?
Have you ever been convicted of a Felony?
If yes, please explain, include dates:
Have you ever been convicted of a Misdemeanor?
If yes, please explain, include dates:

Desired Employment
Position:
Date Available to Start Work:
Salary Expectations:
Type of Employment Preferred:
How were you referred to PDSi?
Have you applied for employment with us before?

High School
Name of High School:
Location of High School:
Number of years of High School Completed:
Did you Graduate from High School?
Trade/Technical School
Name of Trade/Technical School:
Location of Trade/Technical School:
Number of years of Trade/Technical School Completed:
Did you Graduate from Trade/Technical School?
Trade/Technical School Degree:
College
Name of College:
Location of College:
Number of years of College Completed:
Did you Graduate from College?
List College Degree:
Graduate Schoo
Name of Graduate School:
Location of Graduate School:
Number of years of Graduate School:
Did you Graduate from Graduate School:
List Graduate School Degree:

Special Training, Professional Membership, Licensure, Etc.

Exclude those which may disclose your race, religion, national origin, age or other protected status.

Employment

This section must be completed in full, even if you send a resume. List your most recent employer first.

Most Recent Employer (1):
Location:
Supervisors Name:
Your Job Title and Department:
Description of work:
Dates Employed:
Wages/Salary:
Telephone:
May we contact your supervisor?
Reason for Leaving

Other Employer (2)
Location:
Supervisors Name:
Your Job Title and Department:
Description of work:
Dates Employed:
Wages/Salary:
Telephone:
May we contact your supervisor?
Reason for Leaving

Other Employer (3):
Location:
Supervisors Name:
Your Job Title and Department:
Description of work:
Dates Employed:
Wages/Salary:
Telephone:
May we contact your supervisor?
Reason for Leaving

Other Employer (4):
Location:
Supervisors Name:
Your Job Title and Department:
Description of work:
Dates Employed:
Wages/Salary:
Telephone:
May we contact your supervisor?
Reason for Leaving

References

Please list three (3) Professional references of persons who are best qualified to comment on your experience and/or educational background. Do not list relatives.

Name:
Company:
Address:
Relationship
Phone:
Years Acquainted:

Name:
Company:
Address:
Relationship
Phone:
Years Acquainted:

Name:
Company:
Address:
Relationship
Phone:
Years Acquainted:

I certify that all of the information furnished in this employment application is true and complete to the best of my knowledge.
I authorized past and present employers, educational institutions and references to verify information on the application and I release them to provide additional information relating to my past employment, educationand performance as requested by PDSi.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge.
I hereby understand and acknowledge that any employment relationship with PDSi is of an "at will" nature, which means that my employment and compensation can be terminated with or without cause and with or without notice at any time at the option of either PDSi or myself. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of PDSi.
I understand that this online application is being submitted via e-mail.

By clicking submit below, I agree to the above information.

About PDSi

Employment Application

Personal Information

Desired Employment

High School

Trade/Technical School

College

Graduate Schoo

Special Training, Professional Membership, Licensure, Etc.

Employment

References