Employment Application Step 1 of 6 16% Your Personal InformationYour Name(Required) First Last Your Email Address(Required) Enter Email Confirm Email Your Home Address(Required) Street Address Unit / Suite Number City State Zip Code Your Phone(Required)Best Time To Call You(Required)When is the best time for us to reach you via telephone?Best Time To Call YouMorningsEarly AfternoonLate AfternoonEarly EveningPosition You're Applying For(Required) Referral Source Advertisement Friend Relative Walk-In Employment Agency Other Other Referral Source If employed and you are under 18, can you furnish a work permit? Yes No Have you filed an application here before? Yes No Date of Previous Application MM slash DD slash YYYY Have you ever been employed here before? Yes No Date of Previous Employment MM slash DD slash YYYY Are you employed now? Yes No May we contact your past/present employer? Yes No Past/Present Employer's Contact InformationAre you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes No (Proof of citizenship or immigration status may be required upon employment)On what date are you available for work? MM slash DD slash YYYY Are you available to work: Full Time Part Time Shift Work Temporary Are you on a lay-off and subject to recall? Yes No Can you travel if the job requires? Yes No Have you been convicted of a felony in the last 7 years? Yes No Felony ExplanationVeteran of the U.S. military service? Yes No Which branch of the military? Do you have any physical, mental or medical impairment or disability that would limit your job performance for the position for which you are applying? Yes No Please explainAre there workplace accommodations which would assure better job placement and/or enable you to perform your job to your maximum capability? Yes No Please explainIndicate what foreign languages you speak, read, and/or write.Please describe Fair, Good, or Fluent in each languageList professional, trade, business or civic activities and offices held.(Exclude those which indicate race, color, religion, sex or national origin)Give name, address and telephone number of three references who are not related to you and are not previous employersSpecial Employment Notice to Disabled Veterans, Vietnam Era Veterans, and Individuals With Physical Or Mental Handicaps. Government contractors are subject to Section 402 of the Vietnam Era Veterans Readjustment Act of 1974 which requires that they take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and Section 503 of the Rehabilitation Act of 1973, as amended, which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals. If you are a disabled veteran, or have a physical or mental handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodation to enable you to perform the job in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect any consideration you may receive for employment.If you wish to be identified, please sign below. Handicapped Individual Disabled Veteran Vietnam Era Veteran Type Name as Digital Signature Employment ExperienceEmployer Employer Address Dates EmployedFromTo Add RemoveWork Performed Job Title Hourly Rate/SalaryStartingFinal Add RemoveSupervisor Reason for Leaving Employer #2Employer Employer Address Dates EmployedFromTo Add RemoveWork Performed Job Title Hourly Rate/SalaryStartingFinal Add RemoveSupervisor Reason for Leaving Employer #3Employer Employer Address Dates EmployedFromTo Add RemoveWork Performed Job Title Hourly Rate/SalaryStartingFinal Add RemoveSupervisor Reason for Leaving Employer #4Employer Employer Address Dates EmployedFromTo Add RemoveWork Performed Job Title Hourly Rate/SalaryStartingFinal Add RemoveSupervisor Reason for Leaving EducationElementary School Name Elementary Years Completed45678High School Name High School Years Completed9101112High School Diploma/Degree Describe High School Course of StudyDescribe High School Specialized Training, Apprenticeship, Skills, and Extra-Curricular ActivitiesCollege/University College/University Years Completed1234College/University Diploma/Degree Describe College/University Course of StudyDescribe College/University Specialized Training, Apprenticeship, Skills, and Extra-Curricular ActivitiesGraduate/Profession School Name Graduate School Years Completed1234Graduate Diploma/Degree Describe Graduate Course of StudyDescribe Graduate Specialized Training, Apprenticeship, Skills, and Extra-Curricular ActivitiesHonors Received State any additional information you feel may be helpful to us in considering your application:Agreement I agree to the followingI certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and 'is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company,Upload Your ResumeAccepted file types: pdf, doc, docx, Max. file size: 100 MB.upload your resume in .pdf, .doc or .docx formatSignatureComplete this math problem - five plus two = Contact 2025 Shady Plain Rd.Apollo, PA 15613 solutions@rearicktooling.com 724.478.1135 724.478.1137 Location Request a Quote
