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400 North Zarfoss Drive
Suite B.
York, PA 17404
717-900-1084

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Applicant Information
Full Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Date Available*
Month
Day
Year
Desired Salary/Rate*
Are you authorized to work in the US?*
Have you ever been convicted of a felony?*
Have you ever worked of us before?*
How did you hear about us?*
If employee referral or other, please specify
Position Applied For*
Education
High School*
First
High School Address*
City State
Did you graduate?*
College/University
First
College/University Address
City State
Did you graduate?
Graduation or expected graduation date
Degree
Other Education
First
Other Education Address
City State
Did you graduate?
Graduation or expected graduation date
Degree/Certificate
Employment
Most Recent Employer*
Address*
Street Address City State ZIP Code
Phone*
Job Title*
Salary*
Starting Salary Ending Salary
Responsibilities*
Reason for Leaving*
Other Employer
Address
Street Address City State ZIP Code
Phone
Job Title
Salary
Starting Salary Ending Salary
Responsibilities
Reason for Leaving
Other Employer
Address
Street Address City State ZIP Code
Phone
Job Title
Salary
Starting Salary Ending Salary
Responsibilities
Reason for Leaving
Military Service
Military Service
Branch From To Rank at Discharge Type of Discharge
Disclaimer*
I agree to the disclaimer below
I hereby give Frasier-Campbell Wire & Cable, Inc. the right to make a thorough investigation into my previous employment, education and references; and I release from all liability all persons, companies, corporations supplying such information. I release, indemnify and hold harmless Frasier-Campbell Wire and Cable, Inc. from and against all liability which might result from making such an investigation. I understand that any false answer, statement or representation made by me in this application shall constitute sufficient cause for discharge. I also understand that nothing contained in this employment application or granting of interview is intended to create an employment contract between Frasier-Campbell Wire & Cable, Inc. and me for either employment or for the granting of benefits. No promises regarding employment have been made to me, and I understand that no such promises or guarantee is binding upon Frasier-Campbell Wire & Cable, Inc. unless made in writing and signed by the CEO/President. I understand and agree that I have the right to terminate my employment at any time, for any reason or for no reason, and that Frasier-Campbell Wire & Cable, Inc. retains a similar right.

Branch	From	To	Rank at Discharge	Type of Discharge

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Applicant Information

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