Welcome to UltraCom Wireless



Ultracom Wireless Communications Inc.

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Application for Employment (An Equal Opportunity Employer)

(This is a Printable Form or download the PDF version)

Personal Information

Desired Employment

Full time Part time

Yes No

Yes No

Yes No

Yes No

Referral Source?

Walk-in Newspaper/Radio Ad Employment Agency


School Level Name & Location Number of yrs. Attended? Did you graduate? Subjects
Grammar School
High School
Trade, Business, or Correspondence School



Below, give the names of three persons you are not related to, whom you have know at least one year.

Name Address Business Phone Number

Service Record

Yes No

Former Employers

List below last three employers, starting with the most recent one first.

Name previous employer

Name of present, or last employer

Name of present, or last employer

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damages that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

print this application for mailing

Please mail the completed application to:
UltraCom Wireless 5301 Hwy 10 East Stevens Point WI 54481 ATTN: Jodi Heil