Application For Employment

APPLICATION FOR EMPLOYMENT

INSTRUCTIONS: Please read carefully. A separate application must be completed and submitted for each position for which you seek consideration. Resumes will not be accepted in lieu of completed applications, but are considered to be supplemental information. CVI Melles Griot is not obligated to return resumes, transcripts, letters of reference and other information submitted with the application. Persons hired by CVI Melles Griot are required to present proof of identification and of their legal eligibility to work in the United States prior to beginning work. Only persons authorized to work in the United States will be hired for employment.

Date of Application Have you ever applied with us? If yes, when
Name: First: Last: Middle:
Mailing Address: Email:
City:		State: Zip:

Residence Phone:Cell Phone: Business Phone:


Position applied for:

Division/Unit Albuquerque, NM Carlsbad, CA Rochester, NY Covina, CA Other
Type of employment sought: Full Time Part-Time Temporary Seasonal Student Internship

Employment availability (specify) beginning:

If required, will you travel? Yes No

If required, will you work overtime? Yes No

If you are hired, can you provide proof that you are eligible for employment in the United States? Yes No

Have you worked under any other name? Yes No (required to verify education, employment records, and references) If yes, please provide the name:

From what source did you learn of this opening? If other, please specify:

If you were referred by current CVI Melles Griot employee, please specify: Name: Division:
Are you 18 years of age or older? Yes No If no, can you submit a work permit if employed? Yes No

Have you ever been convicted of a crime, excluding misdemeanors and summary offenses? Yes No

If yes, describe in full, including the date, city, state, and disposition of the conviction.
In compliance with federal and state law, qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, spousal affiliation, disability, physical or mental handicap or serious medical condition. Where appropriate, CVI Melles Griot will provide reasonable accommodation on the basis of religion, disability, physical or mental handicap or serious medical condition.

Education

	Name/Location	Number of Years Completed	Did you Graduate?	Major Field of Study

High School
College/University
Graduate
Technical, Vocational, Business, Other

If you have completed any special courses, seminars, and/or training, or received any certificates that would enable you to perform the position for which you are applying, please describe below:

Please check all that apply:
Software skills	Software Skills	Equipment Skills	Equipment Skills
Microsoft Word	3D StudioViz	Spectrophotometer	Optical fabrication and polish
Microsoft Excel	Photoshop	Interferometer	Oscilloscope
Microsoft PowerPoint	MathCAD	Linear Gauges	Spectrum analyzer
Microsoft Access	Mathmatica	Caliper	Surface profiler
Microsoft Outlook	Autodesk Inventor	Mill	Mode analyzer
Labview	Zemax	Lathe	Multimeter
AutoCAD	Code V	Microscope	Beam Profiler
CNC	Oslo	Autocollimator
SmartCAM		Soldering
		Small hand tools
		Power Meter

Employment History (list in order with your most recent employer first)

Please complete this section - "See Resume" is NOT acceptable. Include job related military and volunteer activities. Explain any gaps in employment in the comments section below.

Employer:	Supervisor:
Your Position:	Employer Phone:
Employer Address:
Employed from:	(MM/YY) to: (MM/YY) Full-time Part-time
Your Salary (hourly):	Starting: Ending:
Reason for leaving:
May we contact for a reference? Yes No

Duties

Employer:	Supervisor:
Your Position:	Employer Phone:
Employer Address:
Employed from:	(MM/YY) to: (MM/YY) Full-time Part-time
Your Salary (hourly):	Starting: Ending:
Reason for leaving:
May we contact for a reference? Yes No

Duties

Employer:	Supervisor:
Your Position:	Employer Phone:
Employer Address:
Employed from:	(MM/YY) to: (MM/YY) Full-time Part-time
Your Salary (hourly):	Starting: Ending:
Reason for leaving:
May we contact for a reference? Yes No

Duties

Include a Resume (Optional)
If you have a resume you are welcome to attach it below. A resume is not required to complete this form.

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with CVI Melles Griot is true, complete, and correct. I understand and acknowledge that I may be required to submit to a pre-employment physical, including drug test as a condition of employment with CVI Melles Griot. Should this be required, I agree to such tests, and understand that the results will be maintained confidential and not released to third parties.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from CVI Melles Griot service, whenever it is discovered.

I expressly authorize, without reservation, CVI Melles Griot, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions, and to otherwise verify the accuracy of all information provided by me in this application, resumé, or job interview. I hereby waive any and all rights and claims I may have regarding CVI Melles Griot, its agents, employees, or representatives, for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I authorize the investigation of all statements and information contained in this application. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation. I understand that CVI Melles Griot does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law.

I understand a separate resume must be completed and submitted for each position. If it is determined that my qualifications meet the requirements of the position I applied for, CVI Melles Griot will contact me.

If I am hired, I understand that my employment with CVI Melles Griot will be at-will. This means that I am free to resign at any time, with or without cause, and without prior notice, and CVI Melles Griot reserves the same right to terminate my employment at any time, with or without cause, and without prior notice, except as may be required by law. This application does not constitute any agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of CVI Melles Griot is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the Chief Executive Officer of CVI Melles Griot.

I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

Some CVI Melles Griot job positions require compliance with ITAR regulations, and therefore require US Citizenship or lawful permanent residence.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand, and accept all terms of the foregoing applicant statement.

Signature: Date: (MM/DD/YYYY)