Employment Application

Date:	04 Oct, 2023
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?:	YesNo
		How were you referred to Holaday?
		Wage Desired:

Previous Employment List your most recent employers, starting with your most recent first.

Company Name:		Address:
Dates (mm/dd/yyyy):	to	Supervisor:
Position:		Responsibilities:
Salary:
Reason for Leaving:

Company Name:		Address:
Dates (mm/dd/yyyy):	to	Supervisor:
Position:		Responsibilities:
Salary:
Reason for Leaving:

Company Name:		Address:
Dates (mm/dd/yyyy):	to	Supervisor:
Position:		Responsibilities:
Salary:
Reason for Leaving:

Education

High School:		Address:
Did you graduate?	YesNo	Subjects Studied:

Other Education:		Address:
Did you graduate?	YesNo	Subjects Studied:

Have you applied at Holaday before?	YesNo	Have you ever worked at Holaday?	YesNo If yes, when:
If hired, can you furnish proof that you are elgible to work in the United States?	YesNo	Do you have any commitments or activities with another employer that might affect your employment with us?	YesNo
If hired, can you provide proof that you are at least 18 years of age?	YesNo

Due to ITAR regulations can you prove that one of the following situations apply? I am a US citizen or national. I am a lawful permanant resident in the US. I have recieved political asylum in the US. I have been granted refugee status in the US. I have been granted temporary residence in the US under the 1986 legalization program. YesNo ... *

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.
Gender: MaleFemale Race/Ethnic Origin: Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) A person having origins in any of the original peoples 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. 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 Islanders. Asian (Not Hispanic or Latino) A person having origins in any other original 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 original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above five races. 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. I acknowledge all statements above to be true.

Date:	04 Oct, 2023	Signature*: