Application For Employment Position applying for* Name* First Middle Last Other names you have been employed under: Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone*Cell PhoneEmail* Are you eligible to work in the United States?* Yes No Are you 18 years of age or older?* Yes No If NO, what is your age? Have you ever been employed by Integra Optics, Inc.?* Yes No If YES, dates of employment & reason for leaving:Are you related to any current Integra Optics, Inc. employees?* Yes No If YES, their name & their relationship to you:If required for position, do you have a valid driver's license? Yes No If YES, state of issuance, license #, and expiration date:How did you learn about this employment opportunity ?*Ad In NewspaperJob Bulletin (Posting)WebsiteReferral by EmployeeSocial MediaOtherDesired Salary* EducationPlease list Highschool, College, GED, & other schools attended if applicable.Please list Highschool, College, GED, & other schools attended if applicable.Name Of SchoolCity / StateDid You Graduate?If NO, # of Years Left To GraduateIf YES, Date of GraduationDegree ReceivedMajor Other credentials / licenses / professional affiliations, etc. which are relevant to the job(s) for which you are applying.Other credentials / licenses / professional affiliations, etc. which are relevant to the job(s) for which you are applying.SkillsPlease list technical skills, clerical skills, trade skills, etc. relevant to this position. Include relevant computer systems and software packages of which you have working knowledge, and note your level of proficiency (basic, intermediate, expert)Please list technical skills, clerical skills, trade skills, etc. relevant to this position. Include relevant computer systems and software packages of which you have working knowledge, and note your level of proficiency (basic, intermediate, expert)Work ExperienceBegin with you current or most recent employer. If you held multiple positions with the same organization, detail each separately. Omission of prior employment may be considered falsification of information. Include full-time military or volunteer commitments. PLEASE NOTE: Integra Optics, Inc. reserves the right to contact all current and former employers for references information.Begin with you current or most recent employer. If you held multiple positions with the same organization, detail each separately. Omission of prior employment may be considered falsification of information. Include full-time military or volunteer commitments. PLEASE NOTE: Integra Optics, Inc. reserves the right to contact all current and former employers for references information. Dates Of EmploymentFull Time or Part TimeTitleOrganization NameOrganization AddressSupervisor's NameSupervisor's Phone #Primary DutiesReason For Leaving ReferencesPlease list 3 (three) professional references.Please list 3 (three) professional references.NameRelationshipCompanyCompany AddressPhone # Upload ResumeAccepted file types: jpg, doc, png, pdf, Max. file size: 32 MB.Upload Cover LetterAccepted file types: jpg, doc, png, pdf, Max. file size: 32 MB.CommentsThis field is for validation purposes and should be left unchanged.
