THREE WIRE SYSTEMS, LLC
APPLICATION FOR EMPLOYMENT
3130 Fairview Park Drive STE 425 • Falls Church, VA 22042
Tel: (703) 635-2690 • Fax: (703) 656-4855 • www.threewiresys.com
An equal employment
opportunity employer.
ATTACH YOUR RESUME TO THIS APPLICATION
Last Name
First
Middle
Street Address
City
State
E-mail
Telephone Number
Zip Code
Type of Position Desired?
Salary Desired
Date Available for Employment
$
Do you have any friendships, affiliates and/or family
relationships with any TWS employee, customer of TWS or
anyone doing business with TWS? If yes, give name(s).
Have you ever been known by
another name? If yes, list name,
place, and date of usage, include
maiden name if applicable.
Friends
Yes
Name
Place
Date
Name
Place
Date
No
INDICATE YOUR SOURCE OF REFERRAL TO TWS
Company Employees
State, Local, or Commercial
Employment Agency
(name)
College
Newspaper Advertising
Other
ACADEMIC TRAINING
Provide complete information on all schools you have attended.
Include any special courses and training, technical and military schools.
Do you have a high school diploma/GED?
Name and Location of School
Name of Degree or
Certificate (i.e. BSEE,
MS Finance)
Page 1 of 4
Yes
Received
Diploma/
Certificate?
Yes or No
No
If No, Date
Anticipated
Major Subjects
List any software or equipment with which you are
proficient; include other skills, qualifications,
awards, publications, etc., related to the position
for which you are applying.
EMPLOYMENT HISTORY
1. List all positions including military, part-time and self-employment for the past 10 years.
2. Give specific information about the nature and responsibilities of each position you have held.
3. Start with the most recent position. If space is too limited for listing all of your employment record, you may attach
additional sheets of paper incorporating the format below and sign name and date and attach to application.
Company Name
Type of Business
From
Month
Address
To
Year
Month
Salary
Year
Start
$
Telephone
End
$
Reason For Leaving
Position and Duties
Company Name
Type of Business
From
Month
Address
To
Year
Month
Salary
Year
Start
$
Telephone
End
$
Reason For Leaving
Position and Duties
Company Name
Type of Business
From
Month
Address
To
Year
Month
Salary
Year
Start
$
Telephone
Reason For Leaving
Position and Duties
Page 2 of 4
End
$
Are you at least 18 years of age?
Yes
No
Do you have the legal right to work in the United States?
Yes
No
Note: If hired, you must demonstrate proof of identity necessary to validate your right to legally work in the US.
Do you have an employment contract, nondisclosure agreement or non-compete agreement with a
current or former employer, or are you party to any agreement that directly or indirectly restricts
your right or freedom to provide services as an employee to TWS? Further, are you under any duty
that directly or indirectly restricts your right or freedom to provide services as an employee to TWS?
Please attach a short description of any such agreement or duty, and provide a copy of any such
agreement to TWS.
Yes
No
CLEARANCE INFORMATION
Note: Employment with Three Wire Systems may require a security clearance.
Yes
Have you ever held a security
clearance?
No
If yes, give
approximate dates.
From
To
Level of Clearance
Have you ever had a security clearance suspended, denied, or revoked?
Yes
No
Have you ever terminated employment while an application for a security clearance was pending?
Yes
No
Do you have an application for a security clearance pending at your current place of employment?
Yes
No
Do you currently have any legal/criminal charges pending against you?
Yes
No
Yes
No
Note: Pending charges may have an impact on your ability to obtain a security clearance.
Have you ever been convicted of a felony or misdemeanor?
If yes, explain.
MILITARY SERVICE RECORD
Have you ever been a
member of the Armed
Forces of the U.S.?
Yes
Branch
Highest Rank
No
Page 3 of 4
Type of Discharge
Special Honors
PLEASE READ CAREFULLY APPLICANT’S CERTIFICATION AND AGREEMENT
I hereby certify that the information provided by me in this application is true, correct, and complete. I understand that
I may be refused employment or terminated from employment due to my falsification or my failure to provide complete
information. I authorize the investigation of all statements contained in this Application for Employment as may be
necessary in arriving at an employment decision and release Three Wire Systems from any and all liability associated
with such an investigation. I authorize the companies, schools, and persons named herein to release any employment
and background information they have regarding me, whether or not it is in their records, and hereby release said
companies, schools, and persons from all liability for releasing such information.
I understand that Three Wire Systems has an obligation to all its employees, customers, and the public at large to ensure
safety in the workplace, on company premises, and in the delivery of its services. Therefore, I hereby consent to postoffer, pre-employment screening. I understand that successful completion of the post-offer, pre-employment screening
is required, including criminal record checks, drug/alcohol testing, identity check, credit history check and related checks
necessary for obtaining security clearances.
I understand that if I am employed by Three Wire Systems, I am not guaranteed employment for any specified period of
time and that my employment may be terminated by Three Wire Systems or myself at any time, for any reason, with or
without notice. I understand that Three Wire Systems does not offer any contract or guarantees of employment,
express, implied or otherwise and therefore, any such perceived agreement would be null and void unless recorded in
writing and signed by myself and the Managing Partner of Three Wire Systems. I also understand that completion of this
application, which will remain in effect for ninety days, does not indicate positions are open or obligate Three Wire
Systems in any way.
Signature of Applicant
Date
We appreciate your interest in
THREE WIRE SYSTEMS, LLC and the time
you have taken to prepare this application.
Page 4 of 4