This Organization Esta Organización

Participates in E-Verify Participa en E-Verify

This employer participates in E-Verify and will Este empleador participa en E-Verify y proporcionará
provide the federal government with your al gobierno federal la información de su Formulario I-9
Form I-9 information to confirm that you are para confirmar que usted está autorizado para trabajar
authorized to work in the U.S. en los EE.UU..
Si E-Verify no puede confirmar que usted está
If E-Verify cannot confirm that you are
autorizado para trabajar, este empleador está
authorized to work, this employer is required requerido a darle instrucciones por escrito y una
to give you written instructions and an oportunidad de contactar al Departamento de
opportunity to contact Department of Seguridad Nacional (DHS) o a la Administración del
Homeland Security (DHS) or Social Security Seguro Social (SSA) para que pueda empezar a
Administration (SSA) so you can begin to resolver el problema antes de que el empleador pueda
resolve the issue before the employer can tomar cualquier acción en su contra, incluyendo la
take any action against you, including terminación de su empleo.
terminating your employment. Los empleadores sólo pueden utilizar E-Verify una vez
Employers can only use E-Verify once you que usted haya aceptado una oferta de trabajo y
have accepted a job offer and completed the completado el Formulario I-9.
Form I-9.

E-Verify Works for Everyone E-Verify Funciona Para Todos

For more information on E-Verify, or if Para más información sobre E-Verify, o si

you believe that your employer has usted cree que su empleador ha violado
violated its E-Verify responsibilities, sus responsabilidades de E-Verify, por
please contact DHS. favor contacte a DHS.

888-897-7781
dhs.gov/e-verify

English / Spanish Poster

 EMPLOYMENT APPLICATION
(Rev. 2/99)
NOTICE TO APPLICANTS

You are not required to give information on this form where such information is expressly prohibited by Federal, State or local
laws and the applicant may exclude those responses that may indicate race, creed, sex, marital status, age, color, national
origin, disabilities, military status, ethnicity or union affiliation.

Do NOT provide or write any additional information on this application other than the information requested. Failure to
adhere to this requirement will result in the disqualification of this application from consideration for any employment
opportunities.

Our employment practices are in full accord with State and Federal laws which prohibit discrimination because of race, color,
religion, age, sex, national origin, membership and activities on behalf of a labor organization, disabilities, or ethnicity.

This application may not be reproduced and must be completed at our office or designated project site.

Important! This employment application will only be valid for 30 days from application date. Incomplete applications will
not be considered for employment with this company. If a question does not apply to you, print NA which means “not
applicable”. False or misleading statements on this employment application will result in its removal from consideration for
any current or future employment opportunities with this company.

(PLEASE PRINT)
Position Applied For Date of Application

Last Name First Name Middle Name

Address Number Street City State Zip Code

Telephone Number(s) Social Security Number

* *
- -

If you are under 18 years of age, can you provide required  Yes  No
proof of your eligibility to work?
✓
Have you ever filed an application with us before?  Yes  No
If Yes, give date ✓
Have you ever been employed with us before?  Yes  No
If Yes, give date ✓
Are you currently employed   No
✓ Yes
May we contact your present employer   No
✓ Yes
Are you prevented from lawfully becoming employed in this
country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment pursuant to the IRCA  Yes ✓
 No
On what date would you be available for work?

Wage Expected?

Are you currently on “lay-off” status and subject to recall?  Yes 

✓ No
Can you travel if a job requires it?   No
✓ Yes
Have you been convicted of a felony?  Yes 
Conviction will not necessarily disqualify an applicant from employment ✓ No
Do you hold a valid driver’s license?  Yes
✓  No Driver’s Lic. No. and State

If you are a referral, who referred you to us?

Are you eligible for overtime or shift work? 

✓ Yes  No

Are you a veteran?  Yes 

✓ No

1
EDUCATION
Name and Address Course Years Diploma
of School of Study Completed Degree
Elementary
School
Manuel Uribe Ángel School
High High school
School
Manuel Uribe Ángel School diploma
Instituto Tecnologico Associate
College
Metropolitano (ITM) Telecommunications Degree
Other Technologist
(Specify)

EMPLOYMENT EXPERIENCE
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You
may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected
status.

Employer Dates Employed Work Performed

From To
Address
08/2023 Certification of links with OTDR
Present equipment.
Telephone Number(s) Hourly Rate/Salary Management of optical tools such as:
Starting Final
Traffic Clamp, Fiber Optic Cutter,
Job Title Supervisor Fiber Optic Fusion Splicer.
Technician
telecommunications
Reason for Leaving 16.00 16.00 Basic knowledge
In low-voltage electricity
Employer Dates Employed Work Performed
From To
Address
03/2024 Present
Telephone Number(s) Hourly Rate/Salary
Starting Final
Job Title Supervisor
Wheelchair assistant
Reason for Leaving 12.50 12.50

Employer Dates Employed Work Performed

Ingenieria Y Gestion Administrativa From To
Address Enhanced team collaboration by providing
Envigado, COL 09/2022 05/2023 clear communication of complex findings
Telephone Number(s) Hourly Rate/Salary through visualizations and reports.
Starting Final
Increased efficiency by streamlining data
Job Title
Analyst Supervisor analysis processes and implementing
Telecommunications automation tools.
Reason for Leaving 12.50 12.50 Supported company expansion efforts through
careful market research and competitive
Job opportunity in the USA landscape assessments.
Employer Dates Employed Work Performed
From To
Address

Telephone Number(s) Hourly Rate/Salary

Starting Final
Job Title Supervisor

Reason for Leaving

2
ADDITIONAL INFORMATION
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience. Especially
construction skills in areas other than the primary skill applied for on this application (multi-skill).
Ability to read and interpret architectural plans, Competence in the use of hand and power tools
Common in construction, such as drills, saws, hammers, and screwdrivers, Experience in maintenance and calibration
Of these tools, Construction and repair of brick, block and stone structures.
Ability to mix and apply mortar, as well as to place and level bricks.
Installation of wiring, distribution panels, and electrical components.
Special Licenses

State any additional information you feel may be helpful to us in considering your skills and/or qualifications.

CPR certification
Fiber optic certification
Structured
Note wiring DO
to Applicants: certification
NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE
REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or

without a reasonable accommodation, the activities involved in the
job or occupation for which you have applied? A description of the
activities involved in such a job or occupation is attached. 
✓ Yes  No

REFERENCES: Give the names of three persons not related to you, whom you have known at least one year.

NAME:____________________________________________________________________________

ADDRESS:______________________________________________________ STATE__________ ZIP_______________

POSITION:____________________________________________________ TELEPHONE # _______________________

NAME:____________________________________________________________________________

ADDRESS:______________________________________________________ STATE__________ ZIP_______________

POSITION:____________________________________________________ TELEPHONE # _______________________

NAME:____________________________________________________________________________

ADDRESS:______________________________________________________ STATE__________ ZIP_______________

POSITION:____________________________________________________ TELEPHONE # _______________________

3
APPLICANT’S STATEMENT
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all
statements contained in this application for employment as may be necessary in arriving at an employment decision.

I understand that this application for employment shall be considered active for an open application period of time not to
exceed 30 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to
whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with
this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may
discharge Employee at any time with our without cause. It is further understood that this "at will" employment relationship
may not be changed by any written document or by conduct unless such changes are specifically acknowledged in writing
by an officer of this organization.

I understand that incomplete employment applications will not be considered. Furthermore, I understand that any extra
writing or indications on this employment application will disqualify me from being considered for employment.

I hereby understand and acknowledge that if employed, my first 90 days with the company shall be considered as a
probationary period during which time I may be discharged for any reason with or without cause.

In the event of employment, I understand that, if hired, false or misleading information given in my application or
interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of the
Employer. Any offer of employment tendered to the applicant by this company is conditional and may be contingent upon
successful completion of a drug and/or alcohol test and background information.

___________________________________________________ ___________________________________
Signature of Applicant Date

FOR OFFICE USE ONLY

APPLICATION NO.: _____________________________________________________________

DATE RECEIVED: _________________ TIME REC’D: _________________________________

INACTIVE DATE: _______________________________________________________________

REFERRED BY: _______________________________________________________________

4
 18344 Oxnard St. Suite #101
Tarzana, CA 91356
Tel: 866-570-4949 | Fax: 866-570-5656
[email protected]

Disclosure And Authorization For Consumer Reports

Disclosure

In connection with my application for employment (including contract or volunteer services) or application for
SWECS, Ltd
tenancy with _____________________________________, at _____________________________________________________,
I understand consumer reports will be requested by you (“Company”). These reports may include, as allowed by law,
the following types of information, as applicable: names and dates of previous employers, reason for termination of
employment, work experience, reasons for termination of tenancy, former landlords, education, accidents, licensure,
credit, etc. I further understand that such reports may contain public record information such as, but not limited to:
my driving record, judgments, bankruptcy proceedings, evictions, criminal records, etc., from federal, state, and other
agencies that maintain such records.

In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers
or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant
performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained.

Authorization

I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired
(or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company
to procure such reports at any time during my employment, contract, or volunteer period. I authorize without
reservation, any person, business or agency contacted by the consumer reporting agency to furnish the above-
mentioned information.

This authorization is conditioned upon the following representations of my rights:

I understand that I have the right to make a request to the consumer reporting agency: Background Screeners of
America (“Agency”), 18344 Oxnard Street, Ste. 101, Tarzana, CA 91356, telephone number 866-570-4949, upon
proper identification, to obtain copies of any report furnished to Company by the Agency and to request the nature and
substance of all information in its files on me at the time of my request. The request includes the sources of information
and the Agency, on Company’s behalf, to provide a complete and accurate disclosure of the nature and scope of the
investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such
reports on me which the Agency has previously furnished within the two year period for employment requests, and
one year for other purposes preceding my request (California three years). I hereby consent to Company obtaining the
above information from the Agency. I understand that I can dispute, at any time, any information that is inaccurate in any
type of report with the Agency. I may view the Agency’s privacy policy at their website: www.wescreenusa.com
California, Minnesota and Oklahoma Residents:
I understand that if the Company is located in California, Minnesota or Oklahoma, that I have the right to request a copy
of any report Company receives on me at the time the report is provided to Company. By checking the following box,
I request a copy of all such reports be sent to me. Check here:

I have read and I

understand this page. Applicant Initials

Rev. 05.17.2016 www.wescreenusa.com

California Applicants:
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact
the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (PTZ) Monday through Friday) to obtain all information
in Agency’s file for my review. I may obtain such information as follows: 1) In person at the Agency’s offices, which
address is listed above. I can have someone accompany me to the Agency’s offices. Agency may require this third party
to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency
to disclose to or discuss Agency’s information with this third party; 2) By certified mail, if I have previously provided
identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I
have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain
any information in my file to me and if the file contains any information that is coded, such will be explained to me.
New York Applicants:
I understand that if I am applying for employment in New York, that I have the right to receive a copy of Article 23-A of
the New York Correction Law ____________(initial if this applies).
Washington Applicants:
I understand that if the report is provided to an employer in the State of Washington, that I can contact the following
office for more information regarding my rights under Washington state law in regard to these reports: State of
Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188,
(206) 464-7744.

Please complete all of the fields below:

I understand that I have rights under the Fair Credit Reporting Act and I acknowledge receipt of the
Summary of Rights.

Last Name: First: Middle:

Please check box if you
do not have a middle name.

Social Security #: Date of Birth:

Email: (This is a required Field) [email protected]
Current Address: Previous Address:
Street: Street:
Apt or Unit #: Apt or Unit #:
City: State: FL Zip: 32746 City: State: FL Zip: 32746

Drivers Lic. #: State Issuing:

Former Name/Alias:

X Date:
Applicant Signature

Rev. 05.17.2016 www.wescreenusa.com

Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection
Bureau, 1700 G Street N.W., Washington, DC 20552.

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer
reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as
agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your
major rights under the FCRA.
For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to:
Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
• You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of
consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you –
must tell you, and must give you the name, address, and phone number of the agency that provided the information.
• You have the right to know what is in your file. You may request and obtain all the information about you in the files of a
consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your
Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
• a person has taken adverse action against you because of information in your credit report;
• you are the victim of identity theft and place a fraud alert in your file;
• your file contains inaccurate information as a result of fraud;
• you are on public assistance;
• you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and
from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.
• You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on
information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute
scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive
credit score information for free from the mortgage lender.
• You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete
or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See
www.consumerfinance.gov/learnmore for an explanation of dispute procedures.
• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate,
incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting
agency may continue to report information it has verified as accurate.
• Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency
may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.
• Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid
need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those
with a valid need for access.
• You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out
information about you to your employer, or a potential employer, without your written consent given to the employer. Written
consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.
• You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited
“prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your
name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-
8688.
• You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a
furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
• Identity theft victims and active duty military personnel have additional rights. For more information, visit
www.consumerfinance.gov/learnmore.

Applicant Copy
Rev. 05.17.2016 www.wescreenusa.com
States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may
have more rights under state law. For more information, contact your state or local consumer protection agency
or your state Attorney General. For information about your federal rights, contact:

TYPE OF BUSINESS: CONTACT:

a. Bureau of Consumer Financial Protection
1.a. Banks, savings associations, and credit unions with total assets 1700 G Street NW
of over $10 billion and their affiliates. Washington, DC 20006
b. Such affiliates that are not banks, savings associations, or b. Federal Trade Commission: Consumer Response Center - FCRA
credit unions also should list, in addition to the Bureau: Washington, DC 20580
(877) 382-4357
a. Office of the Comptroller of the Currency
Customer Assistance Group
2. To the extent not included in item 1 above:
1301 McKinney Street, Suite 3450
Houston, TX 77010-9050
a. National banks, federal savings associations, and federal
b. Federal Reserve Consumer Help Center
branches and federal agencies of foreign banks
P.O. Box 1200
b. State member banks, branches and agencies of foreign banks
Minneapolis, MN 55480
(other than federal branches, federal agencies, and insured state
c. FDIC Consumer Response Center
branches of foreign banks), commercial lending companies
1100 Walnut Street, Box #11
owned or controlled by foreign banks, and organizations operat-
Kansas City, MO 64106
ing under section 25 or 25A of the Federal Reserve Act
d. National Credit Union Administration
c. Nonmember Insured Banks, Insured State Branches of Foreign
Office of Consumer Protection (OCP)
Banks, and insured state savings associations
Division of Consumer Compliance and Outreach (DCCO)
d. Federal Credit Unions
1775 Duke Street
Alexandria, VA 22314
Asst. General Counsel for Aviation Enforcement & Proceedings
Department of Transportation
3. Air carriers
400 Seventh Street SW
Washington, DC 20590
Office of Proceedings, Surface Transportation Board
Department of Transportation
4. Creditors Subject to Surface Transportation Board
1925 K Street NW
Washington, DC 20423
Associate Deputy Administrator for Capital Access
United States Small Business Administration
5. Creditors Subject to Packers and Stockyards Act
406 Third Street, SW, 8th Floor
Washington, DC 20416
Associate Deputy Administrator for Capital Access
United States Small Business Administration
6. Small Business Investment Companies
406 Third Street, SW, 8th Floor
Washington, DC 20416
Securities and Exchange Commission
7. Brokers and Dealers 100 F St NE Washington,
DC 20549
Farm Credit Administration
8. Federal Land Banks, Federal Land Bank Associations, Federal
1501 Farm Credit Drive
Intermediate Credit Banks, and Production Credit Associations
McLean, VA 22102-5090
FTC Regional Office for region in which the creditor operates or
9. Retailers, Finance Companies, and All Other Creditors Not Listed Federal Trade Commission: Consumer Response Center – FCRA
Above Washington, DC 20580
(877) 382-4357

Applicant Copy
Rev. 05.17.2016 www.wescreenusa.com