Application for Employment

Your name

Your email

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. 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 at Thomas Manufacturing. 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 Manufacturing 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.

INSTRUCTIONS
Yes

PERSONAL INFORMATION

First Name

Middle Initial

Last Name

Telephone

Cellphone

Street Address

Box

City

State
Alabama - ALAlaska - AKArizona - AZArkansas - ARCalifornia - CAColorado - COConnecticut - CTDelaware - DEFlorida - FLGeorgia - GAHawaii - HIIdaho - IDIllinois - ILIndiana - INIowa - IAKansas - KSKentucky - KYLouisiana - LAMaine - MEMaryland - MDMassachusetts - MAMichigan - MIMinnesota - MNMississippi - MSMissouri - MOMontana - MTNebraska - NENevada - NVNew Hampshire - NHNew Jersey - NJNew Mexico - NMNew York - NYNorth Carolina - NCNorth Dakota - NDOhio - OHOklahoma - OKOregon - ORPennsylvania - PARhode Island - RISouth Carolina - SCSouth Dakota - SDTennessee - TNTexas - TXUtah - UTVermont - VTVirginia - VAWashington - WAWest Virginia - WVWisconsin - WIWyoming - WY

Zip Code

If you are under the age of 18, state your age here:

Age

Are you legally entitled to work in the United States?
YesNoI don't know

** You will be required to comply with the U.S. Immigration regulations to prove your identity and right to work in the United States.

Social Security Number

Record

If you have been convicted of a crime(s), explain in the box above.

Answer these questions for all positions requiring the use of a vehicle:

Have you ever been convicted of a moving traffic violation?
YesNo

If YES, list any occurring within the last 3 years:

Traffic Violation Details:

Have your driving privileges ever been revoked or suspended?
YesNo

Driving Privileges Details:

Do you currently hold a valid U.S. driving license? Please list the state and license number.

Driving License

Do you currently hold a valid U.S. commercial driving license? Please list the state, class, and license number.

Commercial License

EDUCATION

High School (Name & Address):

High School Graduate
YesNo

Highest Grade Completed
123456789101112

Did you obtain a G.E.D.?
YesNo

G.E.D. Grade Point Average:

College or University 1 (Name & Location):

College or University 2 (Name & Location):

Did you graduate from a college or university you listed above?
YesNo

College or University Hours Completed:

College or University Grade Point Average:

College or University Degree:

College or University Major:

College or University Minor:

If you are currently attending a college or university, what is your future graduation date?

College or University Graduation Date:

Other Education:

Awards, Honors & Leadership Roles:

MILITARY SERVICE

Military Branch & Specialty:

Years of Military Service Served:

Years of Military Experience:

Indicate your military experience that may be applicable to your employment at Thomas Manufacturing.

GENERAL EMPLOYMENT INFORMATION

List here the equipment with which you have experience and training.

(Examples: mills, lathes, small tools, forklift, word processor, computers, etc.)

Equipment Familiarization:

Are you willing to relocate? (If applicable.):
YesNo

Salary Expected:

How many hours are you available per week?

Employment Type Sought:

Choose all that apply, but at least 1. Hold down the CTRL key and click to select multiple items.

Work Availability:

Select one.

Indicate the hours you are able to work on the following days.

(Enter "Any time" if you have no restrictions.)

Work Hours – Monday:

Work Hours – Tuesday:

Work Hours – Wednesday:

Work Hours – Thursday:

Work Hours – Friday:

Physical Ability

Are you able to perform the essential functions of the job for which you are applying, including travel, if necessary?

Physical Ability Reason:

If NO, indicate reason.

Employment History

Employer 1 Name & Address (Most recent):

Employer 1 Kind of Business:

Employer 1 Start Date:

Employer 1 End Date:

Employer 1 Start Salary:

(Specify per Hour or per Week.)

Employer 1 End Salary:

(Specify per Hour or per Week.)

Employer 1 Job Title:

Employer 1 Supervisor:

Employer 1 Reason for Leaving:

Specify if you Quit, were Laid Off, Discharged or you Retired and the reason why.

Employer 1 Job Reference:

Above, list the person we should contact for a job reference with telephone number.

Employer 1 Contact:

If you do not want us to contact your former employer for a reference, tell us why not?

Employer 2 Name & Address (Most recent):

Employer 2 Kind of Business:

Employer 2 Start Date:

Employer 2 End Date:

Employer 2 Start Salary:

(Specify per Hour or per Week.)

Employer 2 End Salary:

(Specify per Hour or per Week.)

Employer 2 Job Title:

Employer 2 Supervisor:

Employer 2 Reason for Leaving:

Specify if you Quit, were Laid Off, Discharged or you Retired and the reason why.

Employer 2 Job Reference:

Above, list the person we should contact for a job reference with telephone number.

Employer 2 Contact:

If you do not want us to contact your former employer for a reference, tell us why not?

Employer 3 Name & Address (Most recent):

Employer 3 Kind of Business:

Employer 3 Start Date:

Employer 3 End Date:

Employer 3 Start Salary:

(Specify per Hour or per Week.)

Employer 3 End Salary:

(Specify per Hour or per Week.)

Employer 3 Job Title:

Employer 3 Supervisor:

Employer 3 Reason for Leaving:

Specify if you Quit, were Laid Off, Discharged or you Retired and the reason why.

Employer 3 Job Reference:

Above, list the person we should contact for a job reference with telephone number.

Employer 3 Contact:

If you do not want us to contact your former employer for a reference, tell us why not?

Reason for Application:

Above, please briefly describe why you are applying for this position.

About You:

Above, please describe your strengths and talents and how our company will benefit from your work here.

CONDITIONS OF EMPLOYMENT

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.
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.
I understand that overtime work is a condition of employment.
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) My employment and compensation can be terminated, with or without cause, at any time, 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.
I understand that I may be required to submit to a pre-employment and/or 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 paycheck 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.

Application Signature and Date:

Above, Type your name as a digital signature followed by today's date.