Join the Peninsula Electronics team

PERSONAL INFORMATION
Name:	Last, First, Middle
Present Address:	Line 1: Line 2: City: State: Zip Code:
Permanent Address:	Line 1: Line 2: City: State: Zip Code:
Phone Number:
If Related to Anyone in Our Employ: State name and department (Omit name of spouse)
Referred By:

EMPLOYMENT DESIRED
Position:
Date You Can Start:
Salary Desired:
Are You Employed Now?	Yes No If So May We Inquire of Your Present Employer? Yes No
Ever Applied to this Company Before?	Yes No Where? When?
*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are 40 years of age or older.

EDUCATION
Grammar School:	Name and Location of School Did You Graduate? Yes No Subjects Studied
High School:	Name and Location of School Did You Graduate? Yes No Subjects Studied
College:	Name and Location of School Did You Graduate? Yes No Subjects Studied
Trade Business or Correspondence School:	Name and Location of School Did You Graduate? Yes No Subjects Studied
Subjects of Special Study or Research Work:
What Foreign Languages Do You Speak Fluently? Read? Write?
Activities: Civic, Athletic, Etc.: (Exclude Organizations, the Name or Character of Which Indicates the Race, Creed, Sex, Marital Status, Age, Color or National Origin of its Members.)

EMPLOYMENT HISTORY AND REFERENCES
Former Employers (1): (List Last Four Employers, Starting With Last One First)	Name and Address of Employer From (Month and Year) To Salary Position Reason for Leaving
Former Employers (2): (List Last Four Employers, Starting With Last One First)	Name and Address of Employer From (Month and Year) To Salary Position Reason for Leaving
Former Employers (3): (List Last Four Employers, Starting With Last One First)	Name and Address of Employer From (Month and Year) To Salary Position Reason for Leaving
Former Employers (4): (List Last Four Employers, Starting With Last One First)	Name and Address of Employer From (Month and Year) To Salary Position Reason for Leaving
References (1): Give the Names of Three Persons Not Related To You, Whom You Have Known at Least One Year.	Name Address Business Years Aquainted
References (2): Give the Names of Three Persons Not Related To You, Whom You Have Known at Least One Year.	Name Address Business Years Aquainted
References (3): Give the Names of Three Persons Not Related To You, Whom You Have Known at Least One Year.	Name Address Business Years Aquainted
In Case of Emergency Notify:	Name Address Phone Number

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.

Applicants may also print and fill out the form at the link below. Applications are accepted at both Peninsula Electronics locations.

Peninsula Electronics Employment Application (Adobe Acrobat PDF)

Don't have Acrobat? Get it here.