LASER & FABRICATION SERVICES
12 High Speed Lasers
Your profits soar with Grain Belt
Date:
PERSONAL INFORMATION
Name Last: First: Middle:
Email:
Present Address Street:
City: State: Zip:
Permanent Address Street:
City : State: Zip:
Phone Number: Home Cell
Are You 18 Years or Older? Yes No
Special Questions
Are you legally authorized to work in the U.S.? Yes NoProof of identity and eligibility will be required upon hire.
What Foreign Languages do you speak fluently?
Read?
Write?
Have you been convicted of a felony or misdemeanor within the last 5 years?** Yes No
Describe:
I understand and agree that I may be required to take one or more: Physical examination; Drug screen, as a condition of hiring or continued employment. I agree to consent to take such test(s) at such time as designated by the Company and to release the Company, its directors, officers, agents or employees from any claim arising in connection with the use of such tests. Yes No
**You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.
EMPLOYMENT DESIRED
Position:
Date You can start: Salary desired:
Are You Employed Now? Yes No:
If So May We Inquire of Your Present Employer? Yes No
Ever Applied To This Company Before? Yes No
Where? When?
EDUCATION
GRAMMAR SCHOOL
HIGH SCHOOL
COLLEGE
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL
*The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.
GENERAL
Subjects of Special Study or Research Work
U.S. Military or Naval Service
Rank
Present Membership in National Guard or Reserves
FORMER EMPLOYERS
(List Below Last Three Employers, Starting With The Last One First).
Name of Employer
Address of Employer
Phone Number:
Salary Position
Reason for Leaving
From To
REFERENCES:
Give the Names of Three Persons not Related to You, Whom You Have Known at Least One Year.
Name Address
Phone:
Business Years Acquainted
Can you Perform the Essential Functions of Your Job, With or Without a Reasonable Accommodation? Yes No
Please Describe
In Case of Emergency Notify
Name
Address
Phone Number
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 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 all parties from all liability for any damage that may result from furnishing same to you.
If hired, I understand that my employment is at-will and can be terminated at any time, with or without notice, for any reason at the option of the company or me. Should the company hire me, I agree to observe all the company’s policies, practices and procedures currently in existence and new or revised ones, which may be issued in the future.
Date
Signature