APPLICATION FOR EMPLOYMENT This company is an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by State of Federal Law.
Name: ________________________________________________ Social Security #:____-___-_____ Last First M.I. Date Available to Start: __/__/__
Present Address: ______________________________________________________________________ Street City State Zip Telephone #: Home (_____)____________________ Cell Phone: (_____) ________________________ Email: _____________________________________ Are you available to work:
Full-Time
Part-Time
Shift Work (circle
AM
PM )
If you are under the age of 18, can you provide proof of your eligibility to work?
Yes
No
Have you ever filed an application with us before?
Yes
No
Are you currently employed?
Yes
No
May we contact your present employer?
Yes
No
If yes, when? ____________________________________________________
If yes, name, title and phone number of current employer: ______________________________________________ ______________________________________________ Are you prevented from lawfully being employed in this country due to Visa or Immigration Status?
Yes
No
Are you currently on “lay-off� status and subject to recall?
Yes
No
Have you ever been convicted of a felony?
Yes
No
If yes, please state citation, date and place where offense occured. _____________________________ ___________________________________________________________________________________ What do you consider to be your strongest skills? ___________________________________________ ___________________________________________________________________________________ Please list a time that you were late or absent from work. How did you communicate that to your supervisor? ___________________________________________________________________________________ ___________________________________________________________________________________ Petoskey Plastics Employment Application
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Name: ____________________________________________________ Social Security #:____-___-___ Last First M.I
EDUCATION Name & Location of School
Years Attended
Did You Graduate?
Subject / Major
Elementary School
High School
College
Specialized Training
Do you have US Military Experience?
Yes
No
Discharged Honorably?
Yes
No
If yes, Date Entered: __________ Branch: __________ Rank: _________ Date Discharged: __________ Please provide any additional information such as special skills, training, management experience, equipment operation or qualifications you feel will be helpful to us in considering your application. _____________________________________________________________________________________ _____________________________________________________________________________________
REFERENCES: Three individuals not related to you, whom you have known for at least one year. Name
Address and Telephone Number
Relationship
Years Acquainted
Emergency Contact: ____________________________________________________________________ Name Street City/State Phone
CURRENT & FORMER EMPLOYERS (most recent first)
Date Employer Name, Address, and Telephone Month / Year
Salary Starting/ Ending Wages
Last Position Held / Responsibilities
Petoskey Plastics Employment Application
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Reason For Leaving
CURRENT & FORMER EMPLOYERS cont. Date Employer Name, Address, and Telephone Month / Year
May we contact the employers listed?
Yes
Salary Starting/ Ending Wages
Last Position Held / Responsibilities
Reason For Leaving
No
If not, which one (s)? ___________________________________________________________________ Is there anything else about you which we should know about your work experience or work ethic? _____________________________________________________________________________________ _____________________________________________________________________________________ Please read the following statement carefully before signing to indicate your understanding. I understand that prior to being offered employment I may be requested to take an employment examination. In the event that I have a disability that will affect my ability to take the test, I will so inform the Company prior to the test so that a reasonable accommodation can be made. The Company reserves the right to require medical documentation regarding the need for accommodation. I understand that prior to employment I will be required to submit a drug screen. I certify that the facts contained in this application are true, accurate, and complete to the best of my knowledge and understand that, if employed, falsified statements or omitted material facts on this application may result in my disqualification from consideration for employment, or termination from employment if I have been hired. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated with or without cause, at any time, with or without notice. This provision supersedes any oral or written representation to the contrary unless in writing and signed by both the President of the Company and the person to whom the writing is directed. I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers, except those specifically excepted,* to provide you with any and all applicable information they may have. I hereby release these references and former employers from all liability for any information they may give to the Company.
______________________________________________________ Signature
______________________ Date
Thank you for completing this application – we’re looking forward to hearing about what you can bring to the Plastics team! Please submit your finished application to the location where you would like to work, listed on the other portion of this tear-off application. Best of luck!
For Employer Use Only Interviewed By: ____________________________________ Date: ___________________ Hired:
Yes
No
Starting Date: _______________________ Position: ______________________________________ Wage: ___________ Petoskey Plastics Employment Application
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