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  • Application for Employment

Application for Employment

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.
Applicant Information
Referral Source (Please check the appropriate category and then list the source below)
Best time to call AM/PM
Best time to call phone type
May we contact you at work?
Best time to call AM/PM
If you are under 18 and it is required, can you furnish a work permit?
Have you submitted an application here before?
Have you ever been employed here before?
Is this application request for reemployment following an extended military leave of absence from this company?
If yes, additional information may be requested
Are you legally eligible for employment in this country?
Type of Employment desired
Will you relocate if job requires it?
Will you travel if job requires it?
Able to meet the attendance requirements of the position?
Will you work overtime if required?
Are you able to perform the "essential functions" of the job?
Have you ever been bonded?
Have you ever been convicted of a crime that has not been expunged by a court?
Have you entered into an agreement that might restrict your ability to work?
Employment History
Starting with your most recent employer, provide the following information.
Compensation (Starting)
Starting Compensation Type
Compensation (Final)
Final Compensation Type
May we contact for reference?
Compensation (Starting)
Starting Compensation Type
Compensation (Final)
Final Compensation Type
May we contact for reference?
Compensation (Starting)
Starting Compensation Type
Compensation (Final)
Final Compensation Type
May we contact for reference?
Compensation (Starting)
Starting Compensation Type
Compensation (Starting)
Final Compensation Type
May we contact for reference?
Have you ever been fired or asked to resign from a job?
Skills and Qualifications
Computer Skills (Check appropriate boxes. Include software titles and years of experience.)
Educational Background
Starting with your most recent school attended, provide the following information.
Completed
Completed
Completed
Completed
References
List the names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three schools or personal references who are not related to you.
Related Information
To what job-related organizations (professional, trade, etc.) do you belong?
Exclude memberships that would reveal race, color, religion, sex, national origin, genetic information, citizenship, age, mental or physical disabilities, veteran/reserve, National Guard or any other similarly protected status.
In your current or previous job, have you ever written training materials?
Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers public agencies, licensing authorities and educational institutions and to other wise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied oral or written agreement contract to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

This company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an application from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, genetic information, age, disability, or any other protected status. Examples of prohibited harassment include, but are not limited to, unwelcome physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name-calling, negative stereotyping, possession or display of of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his/her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The company takes all complaints of harassment and all complaints will be investigated promptly and thoroughly.

NOTE: This company complies with Indiana Law prohibiting smoking in enclosed areas within places of employment.

I understand that any information provided by me is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT
I certify that I have read, fully understand and accept all terms for the foregoing Applicant Statement.