Date
Position(s) Desired: (Be as specific as possible)
1.
2.
3.
APPLICATION FOR EMPLOYMENT
POSITION APPLIED FOR:
Referred by:
Date Available for Work:
INSTRUCTIONS: Please read carefully. Every item on this form must be answered to the best of your ability. Please print and use a pen. Your qualifications will be carefully reviewed and you will be given thorough consideration for any suitable vacancy. Upon employment, this application will become part of your permanent record of Thomas Mfg. Keep this in mind as you complete it. Special Note: You are not required to supply any information that is prohibited by Federal, State, or Local law. We are an Equal Opportunity Employer. Thomas Mfg does not discriminate on the basis of race, color, religion, gender, national origin, pregnancy, marital status, citizenship, age, disability or any other legally protected class. You may request assistance in completing this application.
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PERSONAL
First Name
M. I.
Last
Telephone Number:
Street
Box
City
ST
Zip
Cell/Digital Phone
E-Mail Address
If younger than 18, state your age here
Are you legally entitled to work in the United States?**
**You will be required to comply with the US Immigration regulations to prove your identity and right to work in the United States.
Social Security Number
If convicted of a crime(s), explain here:
Answer these questions for all positions requiring the use of a vehicle:
Have you ever been convicted of a moving traffic violation?
If yes, list any occurring within last 3 years:
Have your driving privileges ever been revoked or suspended?
If yes, list here:
___________________________________________________________________________________________________
Do you currently hold a US driving license?
Valid commercial License?
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EDUCATION
High School (Name and Address)
Did you graduate?
If no, last grade completed
G.E.D. Obtained?
Grade Average
College/University (Name and Location)
College/University (Name and Location)
Did you graduate?
If no, number of hours completed
Grade Point Average
Degree
Major
Minor
If attending, date of graduation
Other Education
Awards, Honors, Leadership Roles:
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MILITARY _ not applicable
List service in U.S. Military: Branch
Number of years served:
Military experience that may be applicable to your employment here:
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GENERAL EMPLOYMENT INFORMATION
1. List here equipment with which you have experience and training. (Examples: mills, lathes, small tools, forklift, word processor, computers, etc.):
2. (Ignore this statement if not applicable). Are you willing to relocate?
3. Salary Expected
#of hours you are available per week?
4. Type of Employment sought:
regular full time _ regular part time _ temporary _ seasonal _ as needed
5. Which of the following are you available: Days and/or Nights:
Weekends:
Holidays:
Shift Work:
6. Indicate hours you are available to work on the following days (or check Anytime, if you have no restrictions)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
7. Are you able and willing to perform the essential functions of the job for which you are applying, including travel, if necessary?
• If no, indicate reason:
________________________________________________________________________________________________
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EXPERIENCE: List below all present and past employment, beginning with your most recent employer
1. Employer
Starting Salary
per hour or week
Address
Last Salary
per hour or week
Kind of Business
Supervisor
Job Title
Reason for Leaving:
Quit _ Discharge _ Retired
Dates Employed
to
Why?
For Job Reference, call
at
Please do not contact this employer. Why not?
•••
2. Employer
Starting Salary
per hour or week
Address
Last Salary
per hour or week
Kind of Business
Supervisor
Job Title
Reason for Leaving:
Quit _ Discharge _ Retired
Dates Employed
to
Why?
For Job Reference, call
at
Please do not contact this employer. Why not?
•••
3. Employer
Starting Salary
per hour or week
Address
Last Salary
per hour or week
Kind of Business
Supervisor
Job Title
Reason for Leaving:
Quit _ Discharge _ Retired
Dates Employed
to
Why?
For Job Reference, call
at
Please do not contact this employer. Why not?
•••
4. Employer
Starting Salary
per hour or week
Address
Last Salary
per hour or week
Kind of Business
Supervisor
Job Title
Reason for Leaving:
Quit _ Discharge _ Retired
Dates Employed
to
Why?
For Job Reference, call
at
Please do not contact this employer. Why not?
_____
•••
5. Employer
Starting Salary
per hour or week
Address
Last Salary
per hour or week
Kind of Business
Supervisor
Job Title
Reason for Leaving:
Quit _ Discharge _ Retired
Dates Employed
to
Why?
For Job Reference, call
at
Please do not contact this employer. Why not?
•••
In the following space, please describe briefly why you are applying for this position:
In the following space, please describe your strengths and talents and how our company will benefit from your work here.
CONDITIONS OF EMPLOYMENT
I. The facts as stated on this application are true and correct. I understand that, if employed, false statements on this application may cause my immediate dismissal.
II. I authorize such background investigations and personal reports as deemed necessary to: (1) verify that the information I have supplied is true and accurate: (2) determine my fitness for this job, and: (3) hold harmless those who have the responsibility to develop such a report. A copy of this authorization is as valid as the original.
III. I understand that overtime work is a condition of employment.
IV. In consideration of my employment, I agree to conform to the rules and regulations for employees. I understand: (1) I am an employee at will, (2) This application is not a contract of employment with Thomas Manufacturing, (3) M y employment and compensation can be terminated, with or without cause, at anytime, at the option of either Thomas Manufacturing, or me. I understand that no representative of Thomas Manufacturing, has any authority to enter into any verbal agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and that no document, policy or practice of Thomas Manufacturing, may change the foregoing unless it is expressly titled “Employment Agreement” and signed by both myself and an executive officer of Thomas Manufacturing.
V. I understand that I may be required to submit to a pre-employment, and post-employment test for fitness and/or substance abuse, if not prohibited by law.
- Upon separation of employment, I authorize Thomas Manufacturing, to withhold from my final pay check any monies owed to them by me (if not prohibited by law) for equipment, loans, products, services, materials or other assets in my possession not returned.
- If not prohibited by law, I accept that any employment issue, complaint or conflict that cannot be resolved internally may be referred to Alternative Dispute Resolution.
