| *Position Applied For: |
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| *First Name: |
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| Middle Name: |
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| *Last Name: |
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| *Phone Number: |
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| *E-mail Address: |
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| *Street Address Line 1: |
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| Street Address Line 2: |
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| *City: |
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| *State: |
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| *Zip: |
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| *Are you eligible to work in the United States? |
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| *Are you 18 years old or older? |
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| *Have you ever been convicted of a crime (felony or misdemeanor) other than minor traffic violations? |
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If yes, please explain number of convictions, nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:
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Availability
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| *Monday: |
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| *Tuesday: |
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| *Wednesday: |
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| *Thursday: |
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| *Friday: |
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| *Saturday: |
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| *Sunday: |
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| *What date are you available to start work? |
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| *What is your means of transportation to work? |
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Employment History
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Present or Last Employment
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| *Employer (or "none"): |
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| Address: |
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| Supervisor: |
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| Supervisor's Phone: |
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| Supervisor's Email: |
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| Start Date: |
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| End Date: |
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| Starting Position: |
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| Final Position: |
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Please list the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
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| Reason for leaving (please be specific): |
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| May we contact your present employer? |
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| If not, why not? |
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Previous Employment
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| Employer: |
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| Address: |
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| Supervisor: |
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| Supervisor's Phone: |
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| Supervisor's Email: |
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| Start Date: |
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| End Date: |
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| Starting Position: |
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| Final Position: |
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Please list the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
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| Reason for leaving (please be specific): |
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Previous Employment
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| Employer: |
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| Address: |
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| Supervisor: |
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| Supervisor's Phone: |
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| Supervisor's Email: |
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| Start Date: |
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| End Date: |
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| Starting Position: |
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| Final Position: |
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Please list the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:
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| Reason for leaving (please be specific): |
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Education: High School
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| *Name of School: |
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| *Location: |
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| GPA: |
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| *Did you graduate? |
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| If not, did you get a GED? |
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| Extracurricular activities: |
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Colleges, Business or Trade Schools, Professional Schools:
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| Name of School: |
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| Location: |
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| Major/Area of Study: |
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| GPA: |
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| Did you graduate? |
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| Degree, diploma, or certificate received: |
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| Extracurricular activities: |
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| Name of School: |
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| Location: |
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| Major/Area of Study: |
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| GPA: |
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| Did you graduate? |
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| Degree, diploma, or certificate received: |
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| Extracurricular activities: |
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| Name of School: |
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| Location: |
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| Major/Area of Study: |
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| GPA: |
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| Did you graduate? |
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| Degree, diploma, or certificate received: |
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| Extracurricular activities: |
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Standardized Test Scores:
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| Date taken: |
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| Test: |
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| Score: |
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| Percentile: |
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| Date taken: |
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| Test: |
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| Score: |
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| Percentile: |
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| Date taken: |
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| Test: |
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| Score: |
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| Percentile: |
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| Date taken: |
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| Test: |
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| Score: |
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| Percentile: |
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| Date taken: |
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| Test: |
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| Score: |
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| Percentile: |
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References (not family or employers)
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| *Name: |
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| *Connection to applicant (neighbor, teacher, etc.): |
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| *Phone: |
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| Email: |
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| Name: |
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| Connection to applicant: |
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| Phone: |
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| Email: |
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| Name: |
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| Connection to applicant: |
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| Phone: |
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| Email: |
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Optional essay questions:
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Why do you want to work at Pololu?
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What have you created/made that you are proud of? (examples: built a deck, wrote a poem, etc.)
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How do you approach self-improvement?
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Who is John Galt?
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| *Did you complete this application yourself? |
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| If not, who helped you? |
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| How did you hear about this job opening? |
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An application form sometimes makes it difficult for an individual to
adequately summarize a complete background. Please include a resume
and a cover letter including any additional
information necessary to describe your full qualifications for the
specific position for which you are applying. You may email this
additional information to
jobs@pololu.com
or fax it to us at 702-262-6894.
If scheduled for an interview, you will be required to sign a
printout of your application with the following certifications and releases:
Interview Video Recording Consent
I consent to my interview being video recorded and to that
recording becoming a part of my employment application for use
as Pololu Corporation deems appropriate. I understand that the
recording may be retained as part of my employee record if I am
hired.
Application Certification and Reference Check Release Form
I authorize Pololu Corporation to conduct a reference check with my
present and/or previous employer(s), and with any educational
institution, organization, business, or individual that I have listed
on my employment application, resume, or mentioned in job interviews,
and obtain from them any relevant information about my job
qualifications, including my performance, experience, skills,
credentials, and other factors affecting my suitability for employment.
In addition, I consent to the release of any information about my
performance, experience, education, credentials, abilities, or
work-related characteristics or traits held or known by other
organizations and individuals, including present and/or previous
employer(s), schools and educational institutions, professional or
business associates, friends, and acquaintances that Pololu
Corporation might contact in the course of conducting a reference
check or background investigation of my suitability for
employment. I understand that reference information may include, but
not be limited to, oral and written information about my employment
performance, professional demeanor and character, rehire potential,
dates of employment, and employment history.
In exchange for Pololu Corporation's consideration of my employment
application, I agree not to file or pursue any complaints, claims, or
legal actions of any kind against Pololu Corporation or any of its
employees or agents arising out of their efforts to obtain
work-related information about me. I also agree not to file or
pursue any complaints, claims, or legal actions of any kind against
any business, educational institution, other organization, or
individual that provides work-related information about me to Pololu
Corporation or any of its employees or agents in accordance with the
terms and intent of this release.
I certify that information contained in this application is true and
complete. I understand that false information, misrepresentation of
facts, and omissions may be grounds for not hiring me or for
immediate termination of employment at any point in the future if I
am hired. I authorize the verification of any or all information listed above.
After filling out the form entirely and emailing us any additional
information, please click the button below to submit your application.
