Baycom Itch to Switch Verizon Nextel

	Baycom - Verizon - Nextel

1-800-4BAYCOM

PERSONAL DATA (All fields in RED are required)
Full Name (First, MI, Last):
Street Address:
City, State Zip:	,
Country:
Home Phone Number:
Alternate Phone Number:
Alternate Number Type (Cell, Work, etc.):
Email Address (Required if you want confirmation of your application submission):
How would you like us to contact you?:
Are you a citizen of the United States or do you have a legal right to work in the United States?	Yes No
Have you ever been convicted under law of any violation, the circumstances of which a reasonable person would view as substantially related to the position you are seeking?	Yes No
If yes, please explain:
POSITION INFORMATION Return to Top
Position applying for:
How were you referred to the company?
Please give specific source name (e.g. Flint Journal, etc.)
OBJECTIVE
Give a brief one or two sentence description of the type of employment or position you desire:
EMPLOYMENT HISTORY Return to Top Please tell us about your current or most recent job and employer.
Employer:
Title:
Wage/Salary:
City, State:	,
Start Date (MM/DD/YYYY):
End Date (MM/DD/YYYY):
Description:
Reason for Leaving:
Employer:
Title:
Wage/Salary:
City, State:	,
Start Date (MM/DD/YYYY):
End Date (MM/DD/YYYY):
Description:
Reason for Leaving:
Please tell us about any other positions you have held that relate to the position you applied for:
EDUCATION Return to Top Please fill in your educational background. List the highest degree attained.
High School
Name of School:
Location of School:
Highest Grade Completed:
Did You Graduate?	Yes No
College/Technical School
Name of School:
Location of School:
Highest Grade Completed:
Did You Graduate?	Yes No
College+
Name of School:
Location of School:
Highest Grade Completed:
Did You Graduate?	Yes No
If you have other related training, licenses or certifications that you would like to provide, please describe here:
SKILLS INFORMATION Return to Top
Please list some keywords that define the skills you posses:

All offers of employment are contingent upon the candidate successfully passing a reference check and a drug test. I certify that answers given by me in this application are true and current without any consequential omissions. I understand that any misleading or incorrect statements may render this application void, and if employed, would be cause for termination. I agree that the Company shall not be liable in any respect if my employment is terminated because of false statements, answers, or omissions made in this questionnaire.

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