Arrotin Plastics Appication Form
|
| Name | |
| Address | |
| Phone Number | |
| Employment Desired | |
| Checkboxes | Full Time Part Time Third option |
If applying for temporary work, during what period
of time will you be available? | |
| Are you available for work on weekends? | Yes No |
Would you be available to work overtime, if
necessary? | Yes No |
| If hired, on what date can you start work? | |
| Salary desired: | |
Personal Information |
Have you ever applied to or worked for Arrotin
before? | Yes No |
| If yes, when? | |
Do you have any friends or relatives working for
Arrotin ? | Yes No |
| If yes, state name(s) | |
| If yes, state name(s) | |
| Relationship: | |
| Why are you applying for work at Arrotin ? | |
If hired, would you have a reliable means of
transportation to and from work? | Yes No |
If hired, can you present evidence of your U.S.
citizenship or proof of your legal right to live
and work in this country? | Yes No |
Are you able to perform the essential functions of
the job for which you are applying, either
with
or without reasonable accommodation? | Yes No |
| Paragraph | |
Section BreakA description of the section goes here. |
(Note: We comply with the ADA and consider
reasonable accommodation measures that may be
necessary for eligible applicants/employees to
perform essential functions. Hire may be subject
to passing a medical examination, and to skill and
agility tests.) |
Have you ever been convicted of a criminal offense
(felony or serious misdemeanor)? (Convictions for
marijuana-related offenses that are more than two
years old need not be listed.) | Yes No |
If yes, state nature of the crime(s), when and
where convicted, and disposition of the case. | |
(Note: No applicant will be denied employment
solely on the grounds of conviction of a criminal
offense. The nature of the offense, the date of
the offense, the surrounding circumstances and the
relevance of the offense to the position(s)
applied for may,
|
| Are you currently employed? | Yes No |
| If so, may we contact your current employer? | Yes No |
Education, Training, and Experience |
| High School | |
| Phone Number | |
| Number of years completed | |
| Did you graduate? | Yes No |
| College/University | |
| Phone Number | |
| Number of years completed | |
| Did you graduate? | Yes No |
| Degree | |
| Vocational/Business | |
| Phone Number | |
| Number of years completed | |
| Did you graduate? | Yes No |
| Certification | |
| Health Care Training | |
| Phone Number | |
| Did you graduate? | Yes No |
| Number of years completed | |
| Certification | |
Many of our customers (clients) do not speak
English. Do you speak, write or understand any
foreign
languages? | Yes No |
| If yes, which languages(s)? | |
Do you have any other experience, training,
qualifications, or skills that you feel make you
especially suited for
work at Arrotin? | Yes No |
| If so, please explain: | |
Answer the following questions if you are applying
for a professional position: |
Are you licensed/certified for the job applied
for? | Yes No |
| Name of license/certification: | |
| Issuing State | |
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 HistoryList 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. |
| Company Name | |
| Address | |
| Phone Number | |
| Dates of Employment: | |
| End | |
| Weekly Pay: Start | |
| Ending Pay | |
| Your Position and Duties | |
| Reason for Leaving | |
| May we contact this employer for a reference? | Yes No |
| Company Name | |
| Dates of Employment: | |
| Address | |
| Phone Number | |
| Dates of Employment: | |
| End | |
| Weekly Pay: Start | |
| End | |
| Your Position and Duties | |
| Reason for Leaving | |
| Company Name | |
| Address | |
| Phone Number | |
| Dates of Employment: | |
| End | |
| Weekly Pay: Start | |
| Ending Pay | |
| Your Position and Duties | |
| Reason for Leaving | |
| May we contact this employer for a reference? | Yes No |
Have you obtained any special skills or abilities
as the result of service in the military? | Yes No |
| If so, describe: | |
ReferencesList below three persons not related to you who have knowledge of your work performance within the last three years. |
| Name | |
| Address | |
| Phone Number | |
| Occupation | |
| Number of years acquainted | |
| Name | |
| Address | |
| Phone Number | |
| Occupation | |
| Number of years acquainted | |
Please Read Carefully, Initial Each Paragraph and
type your name belowI hereby certify that I have not knowingly withheld any information that might adversely affect my chances 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. |
| Your Name | |
I hereby authorize Arrotin 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. |
| Your Name | |
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. |
| Your Name | |
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. |
| Your Name | |
I waive receipt of a copy of any public record
described in the paragraph above. | Agree |
| Date | |
| Name | |
| Image Verification |  | |
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