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    YOUR INFORMATION

    First Name*

    Last Name*

    Email*

    Phone*

    Street Address*

    City*

    State*

    Zip*

    Are you a US Citizen, lawful permanent resident?*

    Are you legally able to work in the United States?*

    EMPLOYMENT INFORMATION

    Position Applying For

    Date Available for Work

    Salary Desired

    Shift Desired

    Have you filed an application here before?*

    If yes, When?

    Have you ever interviewed with us in the past?*

    If yes, When?

    Have you ever been employed here before?*

    If yes, When?

    Referral Source:
    Sign Out FrontEmployeeRelativeWalk-inOther

    Name of Source (If Applicable)

    Are you currently employed?*

    May we contact your current employer?*

    If under 18, can you furnish a work permit?*

    Emergency Contact

    Emergency Number

    SKILLS AND QUALIFICATIONS

    Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work in the position you have applied for.

    Educational History

    High School

    Degree Received

    College

    Degree Received

    Other/Trade

    Degree Received

    EMPLOYMENT HISTORY

    Job Title (1):

    Name of Employer

    Position

    Dates of Employment:

    Start Date

    End Date

    Job Title (2):

    Name of Employer

    Position

    Dates of Employment:

    Start Date

    End Date

    Job Title (3):

    Name of Employer

    Position

    Dates of Employment:

    Start Date

    End Date

    *By completing the above, you certify that all answers given herein are true and complete. You authorize investigation of all statements contained in this application for employment as may be necessary in arriving in an employment decision. In the event of employment, you understand that misrepresentation, omission of facts, false or misleading information given in my application or interview(s) may result in discharge. Further, you understand and agree that, if employed by Quality Coils, Inc., your employment is for no definite period of time, is at will, and may be terminated at any time without any cause or notice.
    Quality Coils, Inc. is an Equal Opportunity Employer. Quality Coils, Inc. does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law.
    By signing below, I acknowledge I have read and understand and agree with the above.
    Acceptance:

    Signature*

    Date

    Office Use Only

    Start Date:

    Time

    Department

    Position

    Supervisor:

    Shift: 1st shift2nd shift

    Full/Part Time: Full TimePart Time

    Starting Pay Rate:

    Incentives: Non-IncentiveIncentive

    Starting on the Floor:

    Other:

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    Quality Coils

    Quality Coils, Inc.

    748 Middle Street | Bristol, CT 06010

    Phone: 860.584.0927
    Fax: 860.584.5954


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