Application for Employment

Visit our website at www.captel.com

If you need assistance completing this application or with the interview process, please let us know.
You must complete the entire application. Date:
APPI!A"# I"$%&'A#I%"
Name:
First Middle Initial Last
Address:
Street City State Zip Code
E-mail Address: Primary Phone #:
Alternate Phone #:
Are there any other names under whih you ha!e wor"ed or attended shool# $es No
I% yes& please list %or re%erene he"in' purposes:
Are you le'ally authori(ed to wor" in the )*S*A*# $es No
+I% hired& you will ,e re-uired to pro!ide proo% o% wor" authori(ation*.
Are you at least /0 years old# $es No
+I% not& your employment will ,e su,1et to !eri%iation that you meet state2%ederal minimum a'e re-uirements %or
the type o% wor" you are applyin' %or and ha!e o,tained a !alid wor" permit*.
3a!e you e!er ,een on!ited o% a rime or pleaded 4no ontest5 %or any o%%ense or !iolation other than minor
tra%%i !iolations# $es No +I% yes& e6plain the nature o% the rime& date o% on!ition& and the
state in whih on!ited* Con!itions are not an automati ,ar to employment*5

7o you ha!e any pendin' riminal har'es a'ainst you# $es No
I% yes& desri,e the nature o% the har'es& date issued& and the ounty and state where issued:

3a!e you e!er applied at this ompany ,e%ore# $es No I% yes& when:
3a!e you e!er wor"ed at this ompany ,e%ore# $es No I% yes& when:
P%(I#I%"
Position you are applyin' %or:
Full-8ime Part-8ime Shi%t Pre%erene: /
st
9
nd
:
rd

Salary Pre%erene: ;hen an you start#
How did you learn about us? (Please check all that apply, then specify.)
Newspaper Ad: ;e,site:
<e%erred =y: >ther:


ED)!A#I%"*#&AI"I"+
School Name and Location (city, state)
No. ears
!ttended "a#or Sub#ects
$iploma or
$e%ree &ecei'ed
3i'h
Shool


$es No

Colle'e

$es No
8ype:

?raduate

$es No
8ype:

>ther
+Spei%y.


$es No

#&AI"I"+ !%)&(E(
List any rele!ant trainin' pro'rams ompleted:
(ourse)Seminar
*r%ani+ation
Sponsorin% (ontent
$ate(s)
!ttended





E'P%Y'E"# E,PE&IE"!E
Please list ,elow present and past employment& ,e'innin' with the most reent* Inlude any 1o,-related military
ser!ie assi'nments*
/* Employer: Address: Ph:
7ates Employed Salary
@o, 8itle: Super!isor: From: 8o: Startin': Final:
$our 7uties:
<eason %or Lea!in': I% urrently employed& ontat %or re%erene# $es No
9* Employer: Address: Ph:
7ates Employed Salary
@o, 8itle: Super!isor: From: 8o: Startin': Final:
$our 7uties:
<eason %or Lea!in': I% urrently employed& ontat %or re%erene# $es No
:* Employer: Address: Ph:
7ates Employed Salary
@o, 8itle: Super!isor: From: 8o: Startin': Final:
$our 7uties:
<eason %or Lea!in': I% urrently employed& ontat %or re%erene# $es No
A* Employer: Address: Ph:
7ates Employed Salary
@o, 8itle: Super!isor: From: 8o: Startin': Final:
$our 7uties:
<eason %or Lea!in': I% urrently employed& ontat %or re%erene# $es No
E'P%Y'E"# &E$E&E"!E(
Please 'i!e name& e-mail address& B telephone num,er o% three re%erenes (No relati'es or personal friends),
Name &elationship to !pplicant -."ail !ddress $ay /elephone 0
/
9
:

A"+)A+E (-I(
Indiate any %orei'n lan'ua'es you spea"& read& and2or write:

(-I( A"D .)AI$I!A#I%"(
Summari(e speial 1o,-related s"ills and -uali%iations you a-uired %rom employment or other e6perienes
inludin'& ,ut not limited to word proessin' speed& so%tware "nowled'e& and o%%ie e-uipment*

APPI!A"#/( (#A#E'E"#
PL-!S- &-!$ (!&-12LL 3-1*&- S45N4N5 /H4S 1*&"
All -uali%ied appliants will reei!e onsiderations %or employment without re'ard to se6& rae& olor& national
ori'in or anestry& a'e& disa,ility& marital2!eteran2student status& physial appearane& se6ual orientation& politial
,elie%s& arrest or on!ition reord& a less than honora,le dishar'e %rom the military& et* as prohi,ited ,y Federal&
State& or Loal laws* No in%ormation on this appliation will ,e used %or the purpose o% disrimination*
All in%ormation ontained in this appliation is true and orret to the ,est o% my "nowled'e and ,elie%* I
understand that misrepresentations or omissions o% any "ind may result in denial o% employment or ,e ause %or
su,se-uent dismissal i% I am hired*
I authori(e the ompany to in!esti'ate my responses on this appliation and ontat any or all o% my %ormer
employers or any indi!iduals %amiliar with me or my employment ,a"'round %or the purpose o% !eri%yin' any
in%ormation I ha!e pro!ided and2or %or the purpose o% o,tainin' any in%ormation& whether %a!ora,le or un%a!ora,le&
a,out me or my employment history* I !oluntarily and "nowin'ly %ully release and hold harmless any person or
or'ani(ation that pro!ides in%ormation pertainin' to me or my employment history*
I understand that upon reei!in' a 1o, o%%er& a physial e6amination and dru' sreenin' may ,e re-uired*
<e'ardin' o% whether or not I ,eome employed ,y the ompany& I reo'ni(e that this appliation is not and should
not ,e onsidered a ontrat o% employment* I understand that employment at the ompany is on an at-will ,asis
and that my employment may ,e terminated with or without ause& and without notie& at any time& at my option or
the ompanyCs& unless spei%ially pro!ided otherwise in a written employment ontrat* I %urther understand that
no ompany employee or representati!e has the authority to enter into a ontrat re'ardin' duration or terms and
onditions o% employment other than an o%%ier or o%%iial o% the ompany& and then only ,y means o% a si'ned&
written doument*

AppliantCs Si'nature 7ate Si'ned
/hank you for your interest in our company.
(ap/el is proud to be an -6ual *pportunity -mployer

Pre.-mployment !uthori+ation 7 &elease
All in%ormation pro!ided ,y me in support o% my appliation %or employment is true and orret to the ,est o% my
"nowled'e* I understand that misrepresentations or omissions may ,e the ause %or re1etion or may ,e ause %or
su,se-uent dismissal i% I am hired*
I !oluntarily and "nowin'ly authori(e any %ormer employer& person& %irm& orporation& or'ani(ation& shool& or
'o!ernment a'eny& its o%%iers& employees and a'ents& to release all in%ormation onernin' my %ormer
employment to this prospeti!e employer& its o%%iers& employees& and a'ents& or any other person or entity ma"in'
a written oral re-uest %or suh in%ormation on ,ehal% o% this ompany* I understand that the employment
in%ormation may inlude ,ut is not neessarily limited to per%ormane e!aluations and reports& 1o, desriptions&
disiplinary reports& letters o% reprimand& opinions& and pu,li reord in%ormation re'ardin' my suita,ility %or
employment possessed ,y it* I reo'ni(e that a opy o% this authori(ation and release is as !alid as the ori'inal and
should ,e onsidered as suh*
I !oluntarily and "nowin'ly %ully release and dishar'e& a,sol!e& indemni%y& and hold harmless suh %ormer
employer& person& %irm& orporation& shool& or 'o!ernment a'eny& its o%%iers& employees& and a'ents %rom any
and all laims& lia,ility& demands& auses o% ation& dama'es& or osts& inludin' attorneyCs %ees& present and %uture&
whether "nown or un"nown& antiipated or unantiipated& arisin' %rom or inident to the dislosure or release
e6ept %or the maliious and will%ul dislosure o% dero'atory %ats onernin' my employment made %or the e6press
purpose o% pre!entin' me %rom o,tainin' employment whih the o%%ier& employee& or a'ent dislosin' suh %ats
"nows are untrue*

CandidateCs Si'nature 7ate Print CandidateCs Name
May your urrent super!isor& and2or any re%erenes or indi!iduals assoiated with your C)<<EN8 employer
+inludin' 3uman <esoures 7epartment. ,e ontated# $es No
Comments:
7ate o% =irth +8his in%ormation is only used to ondut a riminal reord he"*.:

AVAILABILITY FORM
CapTel, Inc. is open 7 days a week including olidays. Te Madison call cen!e" is open #$
ou"s a day. Te Milwaukee call cen!e" is open %"o& '()* AM !o +#()* AM. ,lease -ll ou!
you" a.aila/ili!y co&ple!ely, p"o.iding all a.aila/le ou"s and scedule p"e%e"ences.
,lease do no! include ou"s you a"e una/le o" unwilling !o wo"k.
0o"k scedules will /e de!e"&ined /ased upon s!a1ng needs and all applican!s will /e
"e2ui"ed !o p"o.ide so&e a.aila/ili!y on 3a!u"day and4o" 3unday. 5&ployees &us! /e
sceduled a! leas! +' ou"s pe" week and can /e sceduled up !o $* ou"s pe" week,
dependen! on a.aila/ili!y.
To /e eligi/le %o" %ull6!i&e /ene-!s, an e&ployee &us! /e sceduled and wo"k a! leas! )#
ou"s pe" week. 7u"ing e&ploy&en!, scedule cange "e2ues!s &us! /e su/&i!!ed )*
days in ad.ance. App"o.al o% scedule cange "e2ues!s is con!ingen! on s!a1ng
"e2ui"e&en!s. App"o.ed scedules &us! /e wo"ked %o" a &ini&u& o% 8* days /e%o"e
"e2ues!ing addi!ional canges.
9O:R3 ,5R 055;
Applican!
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,R5F5R5<C53 AVAILABILITY

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Latest
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APPROVED HOURS
SCHEDULER USE ONLY
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,lease "ank eac o% !e
%ollowing in o"de" o%
p"e%e"ence. You &ay A
any !a! do no! apply.
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MaBi&u& 9ou"s =up !o $*>
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Consecu!i.e 7ays OC

4n'itation to 4dentify for !ffirmati'e !ction Purposes
!pplicant Name $ate Position !pplied 1or
Please (heck *N-, "ale 1emale
4N$4(!/- /H- !PP&*P&4!/- &!(-)-/HN4( 5&*2P,
3ispani or LatinoDA person o% Cu,an&
Me6ian& Puerto <ian& South or Central
Amerian& or other Spanish ulture or ori'in
re'ardless o% rae
8hite (Not Hispanic or Latino) 9! person
ha'in% ori%ins in any of the ori%inal peoples of
-urope, the "iddle -ast, or North !frica
3lack or !frican !merican (Not
Hispanic or Latino) 9! person ha'in%
ori%ins in any of the black racial
%roups of !frica.
/wo or "ore &aces (not Hispanic
or Latino):!ll persons who identify
with more than one of the 8hite,
3lack or !frican !merican, Nati'e
Hawaiian or *ther Pacific, !sian,
!merican 4ndian or !laska Nati'e
race %roups
Nati'e Hawaiian or *ther Pacific
4slander (Not Hispanic or Latino):!
person ha'in% ori%ins in any of the
peoples of Hawaii, 5uam, Samoa, or
other Pacific 4slands
!sian (Not Hispanic or Latino):! person
ha'in% ori%ins in any of the ori%inal peoples of
the 1ar -ast, Southeast !sia, or the 4ndian
Subcontinent, includin%, for e;ample (ambodia,
(hina, 4ndia, <apan, =orea, "alaysia, Pakistan,
the Philippine 4slands, /hailand, or >ietnam
!merican 4ndian or !laska Nati'e
(Not Hispanic or Latino):! person
ha'in% ori%ins in any of the ori%inal
peoples of North and South !merica
(includin% (entral !merica), and who
maintain tribal affiliation or
community attachment
H*8 8-&- *2 &-1-&&-$ /* /H4S <*3,
Ad!ertisement
-mployment &eferral -mployment !%ency 5o'ernment !%ency &ecruiter
School)(olle%e State <ob Ser'ice /emporary !%ency 8alk 4n *ther

CapTel Inc. is subject to certain governmental record keeping and reporting requirements for the administration of civil rights laws and regulations.
In order to comply with these laws, the employer invites employees to voluntarily self-identify their race and ethnicity. ubmission of this information
is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in
accordance with the provisions of applicable laws, e!ecutive orders and regulations, including those that require the information to be summari"ed
and reported to the federal government for civil rights enforcement. #hen reported, data will not identify any specific individual.