First name:
Last name:
Address No.& Street
City
State:
Zip:
Business Phone:
Home Phone:
Employment Desired
Are you Applying for:
Regular Full Time Work: yes
no
Regular part time
no
Temporary work, e.g summer or holiday work
no
What days are you avialible for work?
If applying for temporary work, during what time period will you be available?
From:
To:
Are you available for work on weekends? Yes
No
If hired what date can you start work?
Salary Desired
Personal Information
Have you ever applied to worked for ARROTIN PLASTIC MATERIALS before? yes
no
If yes when?
Do you have any relatives working for ARROTIN PLASTIC MATERIALS? yes
no
IF yes, state names(s) and relationship
Name
Relationship
Name
Relationship
If Hired, would have a reliable means of transportation? yes
no
Are you at least 18 years old?(If under 18, hire is subject to verification that you are of minimum legal age.)yes
no
Are you able to preform the essential funtions of the job? yes
no
If no, describe the funtions that cannot be performed.
(Note: we comply with the ADA and consider reasonable accomidation measures that may be necessary for eligble applicants/employees to perform essential job functions. Hire may be subjected passing a medical examination, and skill and agility tests.)
Have you been convicted of a criminal offense
(felonly or serious misdemeanor)?yes
no
(Convictions for misdemeanor marijuana-realted offenses that are more than two years old need not to be listed..)
If yes, state the nature of crime(s), when and where convicted, and disposition of the case.
Are you currently employed? yes
no
If so, may we contact your employer? yes
no
Education, Training, and Experience
High School
Address
City
State
Zip
Did you graduate? Yes
No
College/University
Address
City
State
Zip
Did you graduate? Yes
No
Vocational Business
Address
City
State
Zip
Did you graduate? Yes
No
Health Care Training
Address
City
State
Zip
Did you graduate? Yes
No
Many of our customers (clients) do not speak English. Do you speak, write or understand any foreign languages? Yes
No
If yes, which language(s)
Do you have any other experince or training, qualifications, or skills that you feel make you especially suited for work at ARROTIN PLASTICS? Yes
No
If so please explain
Answer the following if you applying for a professional position:
Are you licensed/certified for the job applied for? Yes
No
Name of license/certification:
Issuing State
License/certification number
Has your license/certification ever been revoked or suspended? Yes
No
If yes, state reason(s), date of revocation or suspension, and date of reinstatement.
Employment History
List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. You must complete this section even if attaching a resume.
Name of Employer
Telephone
Type of Business
Supervisor's name
Adress & Street
City
State
Zip
Your Position and duties
Reason for leaving
May we contact employer for a reference? Yes
No
Name of Employer
Telephone
Type of Business
Supervisor's name
Adress & Street
City
State
Zip
Your Position and duties
Name of Employer
Telephone
Type of Business
Supervisor's name
Adress & Street
City
State
Zip
Your Position and duties
Reason for leaving
May we contact employer for a reference? Yes
No
Name of Employer
Telephone
Type of Business
Supervisor's name
Adress & Street
City
State
Zip
Your Position and duties
Reason for leaving
May we contact employer for a reference? Yes
No
Name of Employer
Telephone
Type of Business
Supervisor's name
Adress & Street
City
State
Zip
Your Position and duties
Reason for leaving
May we contact employer for a reference? Yes
No
Name of Employer
Telephone
Type of Business
Supervisor's name
Adress & Street
City
State
Zip
Your Position and duties
Reason for leaving
May we contact employer for a reference? Yes
No
Please Read Carefully, Initial Each Paragraph and Sign Below .
I hereby certify that I have not knowingly withheld any information that might adversely affect mychances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize ARROTIN PLASTIC MATERIALS to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. (Have you ever applied to or worked for)
I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.
Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below. (I waive receipt of a copy of any public record described in the paragraph above) Unchecked I waive receipt of a copy of any public record described in the paragraph above.
Siganture
Date
