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*Required information.
Date
First name *
Middle name
Last name *
Maiden name (if applicable)
Present address *
How long at current address *
Phone *
Are you 18 years old or older?
Are you currently authorized to work in the United States? * (Proof of eligibility will be required if hired)
Have you ever been convicted of a crime/felony? *
Please describe offense:
Position applied for:
Wage desired:
Days/hours available to work:
Do you have a valid driver’s license?
Driver’s license #
State of issue
License expiration date
Do you have your own transportation?
If No, please describe means of transportation to and from work:
Can we contact your present/previous employer(s)?
Have you ever applied to, or worked for this company before?
If Yes, When and position held:
Do you know anyone currently working here? If so, who?

Education - High School

Name of school
Address of high school
# of years completed
Did you graduate?

Education - College

Name of school
Address of college
# of years completed
Did you graduate?

Education - Trade School

Name of school
Address of college
# of years completed
Did you graduate?
Special skills or training:

Education - Military

Have you ever been in the Armed Forces?
If yes, which branch?
Rank held?
Date entered?
Discharge date?
Honorable discharge?
If No, please describe details of discharge?

Work Experience - Employer #1

(List the last three employers, starting with the most recent.)

Name of employer #1 *
Employer #1 address * Please provide: number, street, city, state and zip code)
Employer #1 phone *
Employment dates From-To
Starting pay rate
Ending pay rate
Job title/position
Name of supervisor
Reason for leaving (be specific)
List job duties

Employer #2

Name of employer #2 *
Address of employer #2 * Please provide: number, street, city, state and zip code)
Employer #2 phone *
Employment dates From-To
Starting pay rate
Ending pay rate
Job title/position
Name of supervisor
Reason for leaving (be specific)
List job duties

Employer #3

Name of employer #3 *
Address of employer #3 * Please provide: number, street, city, state and zip code)
Employer #3 Phone *
Employment dates From-To
Starting pay rate
Ending pay rate
Job title/position
Name of supervisor
Reason for leaving (be specific)
List job duties

Reference #1 - (Please list three references, other than relatives)

Reference Full Name
Reference's address (Please give us address, city, state and Zip code)
Reference phone number
Reference's employer

Reference #2

Reference full name
Reference's address (Please give us address, city, state and Zip code)
Reference phone number
Reference's employer

Reference #3

Reference full name
Reference's address (Please give us address, city, state and Zip code)
Reference phone number
Reference's employer

Hobbies or Other Activity Involvement

Please list any background, experience, or qualifications that you believe should be considered in evaluating your qualifications for employment.  You may include hobbies, volunteer experience, and other activities you believe relevant.

Hobbies, volunteer experience, or other activities:

AUTHORIZATION

“I certify that all the information submitted by me on this application is true and complete to the best of my knowledge.  I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected. 

I further understand that my employment with Controlled Plating shall be probationary for a period of sixty (60) days, and further that at anytime during the probationary period or thereafter, my employment relationship with Controlled Plating and/or compensation is terminable at will for any reason by either party with or without cause, with or without notice.

I authorize investigation of all statements contained herein, as well as the references and employers listed above to give you any and all information concerning my previous employment.  I release the company from all liability from any damage that may result from utilization of such information.

In consideration of my employment, I agree to conform to the company’s rules and regulations.  I understand that no company representative, other than the President – and then only in writing and signed by the President – has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.”

“I have made application for employment with Controlled Plating Technologies, Inc.  I hereby request and authorize you to furnish Controlled Plating Technologies, Inc with any information concerning my employment record, character, habits and ability.  I do hereby release all entities and individuals concerned from any claims, suits and liabilities for any damage whatsoever resulting from their actions and conduct in responding to this request and the giving of such information.”

 

Signature of applicant *
Date: *
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