APPLICATION FOR EMPLOYMENT     Thomas Manufacturing, Inc.                Name______________________________________                                                     Date________________________________________                           Position(s) Desired: (Be as specific as possible)                           1.  _________________________________________                           2.  _________________________________________                             3.  _________________________________________   APPLICATION FOR EMPLOYMENT DATE: _________________ 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, marital status, disability or any other legally protected class.   You may request assistance in completing this application. •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• PERSONAL Name_____________________________________________________ Telephone Number: (      )____________________                                  First                                        M. I.                         Last                    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?**   _ yes           _ no **You will be required to comply with the US Immigration regulations to prove your identify and right to work in the United States. If convicted of a crime(s), explain here:__________________________________________________  _ No convictions Answer these questions for all positions requiring the use of a vehicle:  Have you ever been convicted of a moving traffic violation? _ yes           _ no  If yes, list any occurring within last 3 years:_______________________________________________________________________________________________ Have your driving privileges ever been revoked or suspended? _ yes      _ no  If yes, list here:________________________ ___________________________________________________________________________________________________ Do you currently hold a US driving license? _ yes _ no   Valid commercial License?_____________________________ ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••     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: ______________________________________________________________________ ___________________________________________________________________________________________________ •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• MILITARY _ not applicable List service in U.S. Military: Branch_________________________________  Number of years served:________________ Military experience that may be applicable to your employment here:____________________________________________ ___________________________________________________________________________________________________ •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 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 ______   No preference _____hour___ or week____  #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: _ yes _ no                             Nights: _ yes _ no  Weekends: _ yes _ no                                      Holidays: _ yes _ no                 Shift Work: _ yes _ no 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          _____to_____   _____to_____   _____to_____   _____to_____   _____to_____   _____to_____    _____to_____         _ Anytime             _ Anytime            _ Anytime           _ Anytime            _ Anytime         _ Anytime         _ Anytime 7.     Are you able and willing to perform the essential functions of the job for which you are applying, including travel, if necessary?      _ yes _ no _ don’t know    • If no, indicate reason: _ need different hours    _ need different days      _ need more training, Other, (explain accommodation needed:) ________________________________________________________________________________________________ •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 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 _________________     _ Laid Off    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 _________________     _ Laid Off    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 _________________     _ Laid Off    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 _________________     _ Laid Off    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 _________________     _ Laid Off    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. DATE____________________   SIGNATURE____________________________________________________________