Personal Information

First Name

Last Name

Street Address

City

State

Zip

Phone

(###)

###

####

Alternate Phone

(###)

###

####

Employment Desired

Position applying for

How did you hear about this position?

Date available to start

YYYY

Desired Hours

Full-time, part-time, etc.

Education

High School

Name of High School

Location of High School

Dates Attended High School

Degree/Diploma in High School

Undergraduate College

Name of Undergraduate College

Location of Undergraduate College

Course of Study at Undergraduate College

Dates Attended Undergraduate College

Degree/Diploma from Undergraduate College

Graduate/Professional

Name of Graduate/Professional School

Location of Graduate/Professional School

Course of Study at Graduate/Professional School

Dates Attended Graduate/Professional School

Degree/Diploma from Graduate/Professional School

Other

Name of Other Education

Location of Other Education

Course of Study at Other Education

Dates Attended Other Education

Degree/Diploma from Other Education

Employment History

List below all present and past employers over the past ten years, starting with your most recent employer. Account for all periods of unemployment.

Employer 1

Employer 1 Name

Current Employer?

Yes

Employer 1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Pay Rate

Ending Pay Rate

Employer 1 Phone

(###)

###

####

Employer 1 Supervisor(s)

Employer 1 Start Date

YYYY

Employer 1 End Date

YYYY

Employer 1 Job Duties

Employer 1 Reason(s) for Leaving

Employer 2

Employer 2 Name

Current Employer?

Yes

Employer 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Pay Rate

Ending Pay Rate

Employer 2 Phone

(###)

###

####

Employer 2 Supervisor(s)

Employer 2 Start Date

YYYY

Employer 2 End Date

YYYY

Employer 2 Job Duties

Employer 2 Reason(s) for Leaving

Employer 3

Employer 3 Name

Current Employer?

Yes

Employer 3 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Pay Rate

Ending Pay Rate

Employer 3 Phone

(###)

###

####

Employer 3 Supervisor(s)

Employer 3 Start Date

YYYY

Employer 3 End Date

YYYY

Employer 3 Job Duties

Employer 3 Reason(s) for Leaving

Employer 4

Employer 4 Name

Current Employer?

Yes

Employer 4 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Starting Pay Rate

Ending Pay Rate

Employer 4 Phone

(###)

###

####

Employer 4 Supervisor(s)

Employer 4 Start Date

YYYY

Employer 4 End Date

YYYY

Employer 4 Job Duties

Employer 4 Reason(s) for Leaving

Additional Information

Have you ever been employed with this company before?

Yes

If yes, when?

Do you have any friends or relatives currently employed by this company?

Yes

If yes, please provide their names and relationship to you.

Are you currently employed?

Yes

If yes, may we contact your employer?

Yes

Are you currently on "lay off" status and subject to recall?

Yes

If you are under 18 years of age, can you provide proof of your eligibility to work?

Yes

If hired, can you provide proof of U.S. Citizenship or proof of your legal right to work in the U.S.?

Yes

Are you able to perform all of the essential functions of the job for which you are applying, with or without reasonable accommodations?

Yes

If hired, are there any accommodations the company would need to provide so that you can perform all those essential functions and duties of the position being applied for?

Yes

If so, please explain.

If driving is a requirement of the position applied for, have you in the last 7 years been convicted of Driving Under the Influence "(DUI)" or Driving While Intoxicated "(DWI)"?

Yes

If hired, do you have reliable means of transportation to and from work?

Yes

If hired, would you be able to travel or work overtime as needed?

Yes

Have you ever been convicted of a felony or misdemeanor?

**A criminal record does not constitute an automatic bar to employment and will be considered only as it substantially relates to the job in question.

Yes

If yes, please explain:

Please read each of the following statements closely and initial each acknowledging your understanding

Equal Employment Opportunity Statement

This company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by the Federal, State, or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.

Discrimination and Sexual Harassment Policy Statement

This company will not tolerate any form of unlawful discrimination, including sexual harassment. Any employee who engages in unlawful discrimination or sexual harassment will be subject to appropriate discipline, up to and including termination. Prohibited sexual harassment is defined as follows: Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature constitutes sexual harassment when (1) submission to such conduct is made whether explicitly or implicitly a term or condition of an individual's employment; (2) Submission to or action of such conduct by an individual is used as the basis for employment decisions affecting such individuals; or (3) Such conduct has the purpose or effect of unreasonably interfering with an individuals work performance or creating an intimidating, hostile or offensive work environment.

Disclosure to Applicants Concerning Drug/Alcohol Testing

If you are offered a position with the company, you may be given a drug/alcohol test as a condition of employment. Your refusal to timely submit to a drug/alcohol test or your failure to pass such a test means you will not be employed by this company. Neither the collector of specimens nor the medical professional who reviews the test results will be a company employee. The test results will be kept confidential. The individual undergoing testing will not be directly observed while providing the specimen unless there are reasonable grounds to believe the individual may alter or substitute the specimen. Negative test results are required as a condition of employment.

Complete and Accurate Information

I 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 have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other 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.

Acknowledgement

I HAVE READ AND UNDERSTOOD THE ABOVE POLICY STATEMENTS AND AGREE TO BE BOUND BY THEM IF EMPLOYED BY THE COMPANY.

Signature

Today's Date

YYYY

Contact Us

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Weibee Steel

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