August 22, 2014

Application for Employment

An Equal Opportunity Employer


Personal Information

First Name:

Middle Name:

Last Name:

Street Address:

City:

State:

ZIP Code:

Telephone:

Are you 18 years of age?  Yes No

Do you have the legal right to work in the United States?  Yes No

Have you ever been convicted of a felony?  Yes No

If yes, describe in full, including date(s):

Education

Please select highest level of education.

Elementary:

Name/Address:

High School:

Did you graduate?  Yes No

Name/Address:

College:

Degree & Major:

Did you graduate?  Yes No

Name/Address:

Other:

Have you worked for or applied with this company before?  Yes No

If so, when?

Friends or relatives employed here - please list relationship:

Application Information

Check the shifts you wish to be considered for:
 1st (12AM - 8AM) 2nd (8AM - 4PM) 3rd (4PM - 12AM)

Two shift preferences:
 1st (12AM - 8AM) 2nd (8AM - 4PM) 3rd (4PM - 12AM)

Are you willing to work any shift?  Yes No

Would you work overtime, if scheduled?  Yes No

Weekends, if scheduled?  Yes No

If hired, when would you be able to begin work?

Are you currently employed?  Yes No

If yes, date employed:

Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with our company.

Please list previous employment, starting with most recent.

Employer 1

Employer:

Phone Number:

Employment Dates:

Job Title:

Address:

Supervisor:

Summarize work performed and responsibilities:

Hourly rate/salary:

Reason for leaving:

Employer 2

Employer:

Phone Number:

Employment Dates:

Job Title:

Address:

Supervisor:

Summarize work performed and responsibilities:

Hourly rate/salary:

Reason for leaving:

Employer 3

Employer:

Phone Number:

Employment Dates:

Job Title:

Address:

Supervisor:

Summarize work performed and responsibilities:

Hourly rate/salary:

Reason for leaving:

Pre-Employment Statement

I certify that the information given by me in this application is true and correct without omissions of any kind. I authorize an inquiry to be made into the information contained in this application. If I am considered for employment I also agree to submit to a medical examination as a condition of employment, if requested.

Former employers and educational institutions named herein are authorized to give information about me. I hereby release them from all liability for issuing such information. I hereby waive any privilege I have to such information.

I understand and acknowledge that if any misrepresentation or omission of material of facts has been made by me, or if the results of an investigation are not satisfactory for any reason, consideration, offer, or actual employment by the company may be terminated immediately without obligation or liability to me other than payment at the rate agreed upon for service actually rendered, if any.

I consent to a pre-employment drug screen and do hereby authorize the release of the results of any testing or examinations conducted to Profile Extrusion Co.

This application must be completed and signed to be considered. Your application remains on file for six months.

I have read and agree to the Pre-Employment Statement:  YES

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