If you’d like to be considered for employment, please complete our online application.

Employment Application

Millennium Circuits Limited (MCL) is an Equal Opportunity employer and complies with all applicable Federal, State and local laws concerning discrimination in employment. No question in this Application is intended to elicit information in violation of any such law, nor will any information obtained in response to any question be used in violation of any such law. Please read this Application carefully and print your responses in ink or complete electronically. You may submit a personal resume to accompany this Application; however, it is important for you to answer all questions and complete all sections of this Application. We will retain your completed Application in our active files for no less than ninety (90) days.

Step 1 of 13

BACKGROUND INFORMATION
First Name*
Last Name*
Alias(s)
If any of your educational or employment records are under any name(s) other than that shown above, please provide the name(s) under which these records may be located
Address*
Street Address Address Line 2 City State ZIP Code
Contact Information
Please provide your contact details below.
Home/Mobile*
Please provide your home or mobile phone number.
Business/Other
Do you have an alternate number you can be reached at?
Email*
Enter Email Confirm Email

Please provide your email address. For contact purposes only.

Background Information Cont'd
Have you ever been employed by MCL?*
When?*
Have you ever applied to MCL before?*
When?*
Have you reached the age of 18 yet?*
Have you ever been in trouble with the law?*
Since reaching age 18, have you been convicted of a crime which has not been annulled, expunged, or sealed by a court
If you chose "Yes", please explain.*
*A conviction record will not automatically result in your disqualification from employment; convictions will be considered only to the extent they relate to the job for which you have applied. However, failure to disclose a conviction and/or mischaracterization of a conviction will automatically result in your ineligibility for employment and/or termination of employment (even if the conviction would not have barred your employment had it been properly disclosed).
Do you know anyone working for MCL?*
Friend, relative, etc?
Who are they?*
Please identify any relatives or friends currently employed by MCL, indicating job title and place of employment
Existing Do Not Compete Agreements*
Have you signed any agreement with any prior or existing employer which includes any restrictions on your ability to compete; to contact customers, clients or employees; or to use and/or disclose business, client or customer information?
File
If the answer to the preceding inquiry is “Yes,” please provide MCL with a copy of the agreement so that MCL can consider whether, and to what extent, the agreement may preclude and/or restrict your employment with us, if an offer is extended.

Job Interest
Position Applying For
If you know the position you are applying for, please write it in here.
How did you hear MCL was hiring?
Source
Worked with a previous recruiter*
Have you worked with any recruiter, either directly or indirectly, within the previous twenty-four (24) months?
Employment Status Desired*
- Full-Time
- Part-Time
- Temporary
Check all that apply
Days and Hours Desired
ie: M-F 8am-5pm
Salary / Wage Desired*
ie: $45,000 per year or negotiable
Overtime
Choose yes or no if you can work overtime hours
Are you employed now?*
Please choose whether you are or are not employed now.

EDUCATION, TRAINING AND PROFESSIONAL LICENSURE/REGISTRY/CERTIFICATION
Did you graduate from High School?*
High School Name*
Where did you acquire your G.E.D. and in what year?
ie: Community Program - 1997
Address*
City State
Course of Study
Number of years completed
Type of Diploma or Degree?

Did you go to College?*
Please choose yes or no if you went to college.
College Or University*
Please write the name of the college/university you attended.
City/State of College*
City State
Course of Study
Number of years completed
Did you Graduate?*
Did you graduate from another college/university?*
Name of Second College*
City & State of College / University*
City State
Course of Study
Number of years completed
Did you graduate from this college/university?*
Type of Diploma/Degree*
Please explain*
Please explain if you attended another college or university to obtain your degree or if you did not graduate from college.
Type of Degree or Diploma*

Graduate or Professional School
Did you attend Graduate or Professional School*
Name of Graduate or Professional School*
City & State of Graduate or Professional School
City State
Number of Years Completed
Did you graduate?*
Type of Degree or Diploma*
Please explain

Trade of Business School
Did you attend a trade of business school?*
Name of trade/business school*
Cite & State of School
City State
Course of Study
Number of Months
Did you graduate?*
Degree or Diploma Received
Please explain*

Is there anything else you'd like to tell us about your college education?
If you can, please share more about your education.
ie: specialty areas, greek, community services

Liscenses*
Do you hold professional licensure?
List them here*
If yes, please list below all states/jurisdictions in which you now hold or have held licensure as a professional:
Withdrawn or Disciplined?*
Please Explain*
Has your professional license ever been voluntarily withdrawn or have you ever been disciplined by or has your professional license ever been revoked, suspended, reduced, limited, placed on probation, not renewed, or subject to reprimand by a professional board or other regulatory agency?
Do you hold other professional registry/certification?*
Please Explain*
Describe any other education, training, skills or certificates you possess which are relevant to the position for which you have applied:
List all instructional methods/techniques, equipment and computer software applications with which you are proficient and which are relevant to the job for which you have applied.
Present and past memberships in Professional Organizations, including offices held:
Published articles/research:

Employment Record
Have you ever been employed?*
Starting with your current or most recent, list all employers past and present. Include self-employment and summer and part-time jobs. If more space is required, please continue on a separate sheet. You may attach a resume, but you must also complete this Section and MCL, may verify all information disclosed in this Section.
Name of Employer*
Name of your current or most recent employer.
Employers Phone
City & State of Business
City State
Type of Employment
Base Pay
Other Compensation
ie: salary, bonuses, benefits
Type of Business
What industry is this business in?
Date Hired
Date Separated
Name and Title of Immediate Supervisor
Reason For Leaving
Your Employment Title
Please describe your work
Significant Job-Related Accomplishments
How did these accomplishments benefit your employer?
May We Contact This Employer?*
Additional Employers
Do you have a previous employer to the one above?*
Employer 2
Name of Employer*
Name of your current or most recent employer.
Employers Phone
City & State of Business
City State
Base Pay
Other Compensation
ie: salary, bonuses, benefits
Type of Business
What industry is this business in?
Type of Employment
Date Hired
Date Separated
Name and Title of Immediate Supervisor
Reason For Leaving
Your Employment Title
Please describe your work
Significant Job-Related Accomplishments
How did these accomplishments benefit your employer?
May We Contact This Employer?*
Additional Employers
Do you have a previous employer to the one above?*
Employer 3
Name of Employer*
Name of your current or most recent employer.
Employers Phone
City & State of Business
City State
Base Pay
Other Compensation
ie: salary, bonuses, benefits
Type of Business
What industry is this business in?
Type of Employment
Date Hired
Date Separated
Name and Title of Immediate Supervisor
Reason For Leaving
Your Employment Title
Please describe your work
Significant Job-Related Accomplishments
How did these accomplishments benefit your employer?
May We Contact This Employer?*

Additional Job-Related Experience
Write in here
Describe any other experiences (e.g., volunteer work), qualifications, skills or abilities which you possess in addition to those you have outlined above and which you consider important to the successful performance of the job for which you are applying.

References
Name*
Relationship to You*
Occupation and Title*
Phone*
include area code
Years Known*
Additional References
Would you like to add another reference?*
Reference 2
Name*
Relationship to You*
Occupation and Title*
Phone*
include area code
Years Known*
Additional References
Would you like to add another reference?*
Reference 3
Name*
Relationship to You*
Occupation and Title*
Phone*
include area code
Years Known*

STATEMENT CONCERNING SCREENING FOR DRUG AND ALCOHOL ABUSE

I understand that, if I am otherwise qualified for employment, MCL may extend to me a conditional offer of employment and such offer will be contingent upon my successfully passing a substance abuse screening test. With regard to certain positions, the screening test for drugs and alcohol may be part of a more comprehensive health screening examination.

I also understand that I may not be hired if I test positive for alcohol or an illegal drug, refuse to provide a specimen on the date and time required, refuse to consent to testing on the date and time required or provide a false or tampered specimen.

I further understand that, if I become employed by MCL. I will be subject to MCL’s Drug and Alcohol Policy. Included among the provisions of the Drug and Alcohol Policy are requirements for drug and/or alcohol testing whenever MCL has reason to believe that an individual may be under the influence of drugs and/or alcohol while on duty or on the premises of MCL, following an accident, and as part of periodic testing of all MCL employees conducted at MCL’s discretion. Further, the refusal to provide a specimen on the date and time required may result in discharge and constitutes willful misconduct.

You may obtain additional information from MCL’s Drug and Alcohol Policy or from a Human Resources Representative.
APPLICANT’S CERTIFICATION

Please read carefully and, if you need clarification, ask questions before signing below.

I certify that the answers given by me to the foregoing questions and the statements made by me in this Application are correct and complete. I understand that, if I become employed, any misrepresentation or omission of fact in this Application may result in my discharge from employment. I understand that I may be subject to other requirements as part of the application process, including tests of aptitude, skill, or personality.

I authorize MCL as part of its evaluation of my suitability for employment, to verify all education, training and professional licensure/certification/registry claimed by me and to secure from my previous employers and references information concerning my professional accomplishments, reviews, disciplinary action, skills, character and ability. I further authorize MCL to secure from the appropriate sources information concerning criminal convictions and agree to execute the written authorizations necessary for MCL to obtain access to and copies of records pertaining to the aforementioned information. If I am hired, I agree to immediately notify MCL if I am convicted of a felony or any crime involving theft or dishonesty and I further authorize the procurement of criminal record checks throughout my employment with MCL. For these purposes, a photocopy of my signature which appears below shall serve in the same capacity as an original.

In compliance with the federal Immigration Reform and Control Act, I agree, if hired, to provide within three (3) business days from the date my employment begins proof of my identity and eligibility for employment in the United States. I understand that this Application is not a contract for employment and that, if I am employed, both MCL, and I each retain the right to terminate my employment for any or no reason with or without notice at any time. I also understand that no representative of MCL other than its President or a duly authorized representative of the President and then, only in writing, has the authority to enter into any agreement for employment for any specific time or to make any agreement contrary to the foregoing.

Further, I understand that, if I am employed, all materials, equipment and space allocated to me for the discharge of my duties may be inspected as deemed necessary by MCL at its sole discretion.
Agreement*
- Yes, I read the information above and understand that checking this box serves as my signature.
Checking this box confirms that you've read the above statements. This box is required to submit the form.

If you’d like to be considered for employment, please complete our online application.

Employment Application

Step 1 of 13

BACKGROUND INFORMATION

Contact Information

Background Information Cont'd

Job Interest

EDUCATION, TRAINING AND PROFESSIONAL LICENSURE/REGISTRY/CERTIFICATION

Graduate or Professional School

Trade of Business School

Is there anything else you'd like to tell us about your college education?

Employment Record

Additional Employers

Employer 2

Additional Employers

Employer 3

Additional Job-Related Experience

References

Additional References

Reference 2

Additional References

Reference 3

STATEMENT CONCERNING SCREENING FOR DRUG AND ALCOHOL ABUSE

APPLICANT’S CERTIFICATION

Please read carefully and, if you need clarification, ask questions before signing below.

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