Full Name:

          Last:      First:      M.I.:

     Address:

          Street Address:      Apartment/Unit #:

          City:      State: PR      ZIP Code:

     Phone: ( )  -       E-mail Address:

     Date Available:      Social Security: (i.e. 123-45-6789)     Desired Salary: $ /hr

     Position: Select One SCS Technician / Installer

     Are you a citizen of the United States?  Yes No      If no, are you authorized to work in the U.S.? Yes No

     Have you ever worked for R2 Communications Group? Yes No      If so, when?

     Have you ever been convicted of a felony? Yes No

     If yes, explain:
         

     High School:       Address:

     From:   To:     Did you graduate? Yes No     Degree:

     College:            Address:

     From:   To:     Did you graduate? Yes No     Degree:

     Other:               Address:

     From:   To:     Did you graduate? Yes No     Degree:

     1. Full Name:       Relationship: 

        Company:        Phone: 

        Address:

     2. Full Name:      Relationship:

        Company:       Phone: 

        Address:

     3. Full Name:      Relationship:

        Company:       Phone: 

        Address:

     1. Company:       Phone: 

         Address:      Supervisor: 

         Job Title:       Starting Salary: $      Ending Salary: $

         Responsibilities: 

         From:    To:      Reason for Leaving: 

         May we contact your previous supervisor for a reference? Yes No

     2. Company:      Phone: 

         Address:      Supervisor:

         Job Title:      Starting Salary: $      Ending Salary: $

         Responsibilities:

         From:   To:     Reason for Leaving:

         May we contact your previous supervisor for a reference? Yes No

     3. Company:      Phone: 

         Address:      Supervisor:

         Job Title:      Starting Salary: $      Ending Salary: $

         Responsibilities:

         From:   To:     Reason for Leaving:

         May we contact your previous supervisor for a reference? Yes No

     Branch:      From:   To:

     Rank at Discharge:      Type of Discharge:

     If other than honorable, explain:

     Do you certify that your answers are true and complete to the best of your knowledge?
    If yes, write the word 'yes' here: 

    Do you understand that if this application leads to employment, false or misleading
     information in your application or interview may result in your release?
     If yes, write the word 'yes' here: