ACS Home Entertainment » ACS Employment Application

The following information is requested in order to help us make the best possible placement of personnel within the company. All portions of this application must be completed.We appreciate the time you spend fillin in this application. ACS is an Equal Opportunity Employer. If you are applying for a position that requires you to drive a company vehicle (i.e. Dish Installer), PLEASE INCLUDE A CURRENT COPY OF YOUR DRIVING RECORD FROM THE DMV.

PERSONAL INFORMATION

Last*

First*

M.I.

Physical Address*

StreetCityStateZip Code

Previous Address (if either outside VA or if you have lived at address above less than 5 years)

StreetCityStateZip Code

Phone

Alternate Phone

Email

Enter EmailConfirm Email

Position You are Applying For*

Legally able to work in the USA?*

Yes
No

Are you a legal citizen of the United States?*

Yes
No

What date are you available to start?*

How did you hear about this job?

Have you ever been convicted of a misdemeanor?*

Yes
No

Have you ever been convicted of a felony?*

Yes
No

Reason

If you have been convicted of either, please list the nature of the crime, date & place, and the legal disposition of the case.

Are you currently out on bail, the subject of a current warrant for arrest or released on your own recognizance pending trial? Are there any other open cases you are involved in, regardless if you have been convicted or not?*

Yes
No

Details

If you answered yes to the above question, please give us the details.

Are you currently under any contractual obligation to any past or current employer?*

Yes
No

Please list the details regarding the obligation.

Are you now, or have you even been in the military?*

Yes
No

Please list dates of service, branch, rank, general duty assignment. (A copy of your discharge papers may be requested)

What days are you available to work? (Check all that apply)*

What are your available hours?*

EMPLOYMENT HISTORY

(List current or most recent employer first)

Company Name

From Date

To Date

Company Address

StreetCityStateZip Code

Phone

Job Title

Starting Salary

Ending Salary

Reason for Leaving

Name, Title, & Phone Number of Supervisor

Employer #2

Company Name

From Date

To Date

Company Address

StreetCityStateZip Code

Phone

Job Title

Starting Salary

Ending Salary

Reason for Leaving

Name, Title, & Phone Number of Supervisor

Employer #3

Company Name

From Date

To Date

Company Address

StreetCityStateZip Code

Phone

Job Title

Starting Salary

Ending Salary

Reason for Leaving

Name, Title, & Phone Number of Supervisor

Employer #4

Company Name

From Date

To Date

Company Address

StreetCityStateZip Code

Phone

Job Title

Starting Salary

Ending Salary

Reason for Leaving

Name, Title, & Phone Number of Supervisor

REFERENCES

Please list the names, addresses, and telephone numbers of three (3) people who are not related and are familiar with your personal and work-related accomplishments.

Name*

FirstLast

Phone*

Relationship to Reference*

Reference Address*

StreetCityStateZip Code

Reference #2

Name*

FirstLast

Phone*

Relationship to Reference*

Reference Address*

StreetCityStateZip Code

Reference #3

Name*

FirstLast

Phone*

Relationship to Reference*

Reference Address*

StreetCityStateZip Code

I authorize and request that every person, firm, and corporation listed above provide to ACS any pertinent information related to my employment and personal reference information. Furthermore, ACS may request work-related accomplishments to aid in evaluating my candidacy for employment. I hereby release and hold harmless such persons, firms, and corporations from any liability resulting from providing said information to ACS.

To confirm your agreement, please type your last name and last two (2) numbers of your social security number.

Digital Signature*

(ex. Smith99)

EDUCATION

School Information

High School Name

City & State

Completion Date

Major/Program of Study

Degree Obtained

College Name

City & State

Completion Date

Major/Program of Study

Degree Obtained

Other/Technical/Trade School

City & State

Completion Date

Major/Program of Study

Degree Obtained

SPECIAL SKILLS, CERTIFICATIONS, & ACCOMPLISHMENTS

Please list any skills, certifications, and accomplishments pertaining to the job you are applying for. If applying for DISH Network installer position, list any mechanical skills you have acquired either through work or personal experience.

Do you have a computer and/or internet access at home?*

Yes
No

How would you rate your comfortability level with using computers and/or the Internet? *

Novice
Intermediate
Expert

Document Uploads

If you have access to electronic copies of any of the following, it is recommended you upload them here. This is not required, but we strongly encourage it.

Resume

Driving Record

If you do not have an electronic copy, you will need to bring a copy by the office AFTER submitting this online application. You can also fax it to (540) 345-2318 . YOUR APPLICATION WILL NOT BE PROCESSED WITHOUT A DRIVING RECORD.

Disclaimer & Agreement

I certify that the information contained in this application is correct to the best of my knowledge and understand that any misrepresentation or misleading statements in this application, no matter when it is discovered) shall disqualify me from further consideration for employment or shall be grounds for immediate termination from employment at ACS. If employed, i agree to conform to the rules and regulations of ACS and understand that Virginia is an at will work state which means my employment and compensation may be terminated, with or without cause and with or without notice at any time at the option of either ACS or myself.

I further understand that no representative of ACS, other than Mr. Whitcomb, has any authority to enter into any agreement for employment for any specified period of time and any such agreement must be in writing and signed by Mr. Whitcomb to be enforceable.

I acknowledge that consideration for employment is contingent on the results of a background check and drug test.

Therefore, I hereby authorize ACS to:

(1) Investigate the truthfulness of all statements made on this application, including employment history, reasons for leaving, and educational credentials;

(2) Contact my former employers and other listed references or any other persons who can verify information;

(3) Discuss the results of any investigation with other employees of ACS involved in the hiring process.

In addition, I give my consent for all contacted persons, including former employers, to provide information concerning this application, and I release each such person from liability for providing information to ACS.

ACS is an Equal Opportunity Employer.

Terms & Conditions Agreement*

I have read the full disclaimer and I agree to the terms.

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