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Apply for Regional Sales Manager (Dallas, TX)

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Summary
Title:Regional Sales Manager (Dallas, TX)
ID:11012132
Division::RF
Resume
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
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* Phone:
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* Email:
* Date Applied:
Attachments
Cover Letter:
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Application for Employment Rev
PERSONAL INFORMATION
* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):
Yes   No
* Will you now or in the future require sponsoring for employment visa status (e.g., H-1B visa status etc.)?:
Yes   No
* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):
Yes   No
* Have you ever worked for this Company before?:
Yes   No
If Yes, please provide details (Where/When/Job Title):
* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:
Yes   No
If no, please explain:
Are you related to an Amphenol employee?:
Yes   No
If yes, please give name and location:
If you were referred to this job by a current Amphenol employee, please list the employees name here for our referral program:

EMPLOYMENT DESIRED
* When would you be available to begin work?:
* Type of employment desired:
Full-Time
Part Time
Seasonal
* Salary/Hourly rate desired:
* Are you currently employed?:
Yes   No
* If so may we inquire of your present employer?:
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If presently employed, why are you considering leaving?:

EDUCATION
Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location Did you Graduate? Degree Received Subjects Studied/Major
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If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

EMPLOYMENT HISTORY
Give your full employment record, starting with your current or most recent employment

EMPLOYER 1

Dates Employed Employer Name & Address Employer Phone
From:
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To:
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Job Title Supervisor Name & Title May we Contact?
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*
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Yes
No
Responsibilities Reason for Leaving
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EMPLOYER 2

Dates Employed Employer Name & Address Employer Phone
From:

To:
Job Title Supervisor Name & Title May we Contact?

Yes
No
Responsibilities Reason for Leaving

EMPLOYER 3

Dates Employed Employer Name & Address Employer Phone
From:

To:
Job Title Supervisor Name & Title May we Contact?

Yes
No
Responsibilities Reason for Leaving

REFERENCES Please provide three references (not relatives).

Name Relationship Phone Number Email
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AUTHORIZATION
I hereby certify that the answers and statements given by me in this application are correct without consequential omissions of any kind. I understand and agree that a false statement or omission constitutes sufficient cause for withdrawal of any employment offer or my immediate dismissal from employment resulting from this application. I understand and agree that employment by the Company or any of its subsidiaries is conditional upon satisfactory completion of a post-offer physical examination including a post-offer drug test and periodic drug testing where authorized by law and the execution of an intellectual property agreement. If an offer of employment is tendered, it is conditional upon my submittal of documents which prove my work eligibility. These documents are due in three (3) business days from the tender of the offer.
I authorize all persons and companies named above, except my present employer if so noted, to furnish any information regarding me whether or not it is on the records and hereby release them and the Company from all liability for damage and otherwise authorize investigation of all statements contained in this application for employment as they are required to aid the Company in arriving at a fair objective employment decision. I understand that this application in no way constitutes a contract of employment, and that my employment may be terminated by myself or the Company at any time. It is further understood that unilateral statements of policy which appear or may appear from time to time in employment handbooks, manuals, or other Company publications shall not be construed to modify in any way the explicit provisions of the above statement.

I agree to abide by all Company rules, regulations, policies and procedures.

* Signature (type name):
* Date:
General Questions
* Would you be able and willing to travel as needed by the job?
Yes
No
* Are you open to relocation?
Yes
No
* Do you have reliable transportation to get to and from work?
Yes
No
Voluntary Self-Identification of Disability CC-305
Voluntary Self-Identification of Disability

Form CC-305
OMB Control Number 1250-0005
Expires 01/31/2020

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

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You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

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Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

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Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

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Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
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