It is policy of the company not to discriminate in hiring and employment on the basis of race, color, religion, national origin, sex, disability, age or other proteced class as provided by all applicable federal, state or local laws. No question on this application is intended to secure information for an unlawful purpose. Only fully completed applicatons will be considered for employment.

Be sure to read and sign the applicant statement at the bottom of this application. By submitting this application your are electronically signing.

An Equal Opportunity Employer

Employment Application - Location: When are you available to Start?
Full Time Salary Required:
Shift: First: If unemployed, how long?
Are you currently employed: Yes: How did you learn of the opening?
Personal Data
Last Name: Middle Name:
Street Address: State:

Do you have a reliable means of transportation to travel to and from work
which will allow you do consistently arrive at work on time? Yes No

Driver's License Number
CDL Number Are you available to work First Shift?
Restrictions: Are you available to work Second Shift? Yes
Are you available to work overtime? Yes Are you available to work Third Shift? Yes
Are you avalable to work weekends? Yes Days of the week or hours when you are not available to work? Yes
Are you a United States citizen OR do you presently have the legal right to remain and work permanently in the United States If no, do you require sponsorship for employment? Yes If no, are you currently authorized to be employed by any employer in the U.S.? Yes

Are you under 18 years of age? (Proof of eligibility to work will be required)
Yes No

Are you able to meet the attendance requirements of the job? Yes
Other than English what language do you speak? Read?
Have you ever been involuntarily terminated from employment? Yes If yes to involuntarily terminated from employment? please explain:
Are you able to perform the essential functions of the job for which you are applying with or without a reasonable accomodation? Yes Are you willing to travel? Yes
Are you willing to relocate: Yes Were you ever in the United States Armed Forces? Yes
Are you related to anyone in the compnay? Yes If yes, which branch of service?
If yes, please provide the name(s) and relationship(s) Dates of Service:
Skills  
Machines that you can operate (office and factory)  
Education  
Grade School (Name and address) Years Completed 5

High School (Name and address)
Graduate? Yes Year

Years Completed 9
Business, Trade or Technical School (Name and address) Years Completed 1
College (Name and address) Years Completed 1
Post Graduate School (Name and address) Years Completed 1
Employment Record  
Include your current or most recent job first in order. Account for all time including unemployment.  
Employer: Address:
Name & Title of Supervisor: Reason for leaving:
Ending Salary: Major Responsibilities:
Employer: Address:
Name & Title of Supervisor: Reason for leaving:
Ending Salary: Major Responsibilities:
Employer: Address:
Name & Title of Supervisor: Reason for leaving:
Ending Salary: Major Responsibilities:
Employer: Address:
Name & Title of Supervisor: Reason for leaving:
Ending Salary: Major Responsibilities:
Please indentify three professional / business references. At least one, but preferable all three, should be a person who managed or supervised you in prior employment.  
Name: Telephone Number:
Name: Telephone Number:
Name: Telephone Number:

I hereby certify that the informaton / business references on this application of employment is true and correct. I agree that any misrepresentation, falsification or omission in said information shall be cause for immediate dismissal from employment without protest. I understand that this application will be considered active for thirty (30) days. If I have not been employed wihin this time period, I will need to reapply for consideration.

In consideration of my employment, I agree that my employment and compensation can be terminated with or without cause or notice, at the Company's or my option. No employee, other than the General Manager/Owner of the Company has any authority to enter into any agreement for employment for any specific period of time. Any amendment to this statement must be in writing signed by the General Manager/Owner. Likewise, neither the existence of the Company's employee benefits, nor the programs and plans providing them, nor summaries of descriptions thereof are intended to, or do, alter the at will nature of employment.

By submitting this online application, I authorize the Company to obtain a copy of my credit report for employment purposes only. I understand that I can obtain a copy of my consumer credit report by making a written request to the Company and that the report, along with the name, address and phone number of the credit reporting agency as well as a statement of my rights under the federal Fair Credit Reporting Act, will be provided to me in the event an adverse employment decision is made based on the information contained in my credit report. I also authorize the company to investigate my background and to obtain any and all information that may concern me, including but not limited to, information as to my character, general reputation, personal characteristics and mode of living. I further consent to being discussed by any person so contacted and hereby waive any and all rights to bring any action for defamation, invassion of privacy or any similar cause against anyone contacted as a result of what he/she may say about me.

The Company is a Drug-Free Workplace. I understand that if am offered employment, I will be required to submit to a physical examination including a drug test. I understand that any offer of employment is contingent upon satistactorily completing the physical and/or drug test. I understanding by submitting this online application form I am also consenting to a preemployment physical and drug test and hereby release the Company from any liability or damages in connection with, or reliance upon, such physical and drug test.

If requested by the management at any time, I agree to submit to search of my desk or locker that may be assigned to me.

Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime, shift work, a rotating work schedule, a schedule other than Monday through Friday or temporary assignment at other company facilites.