Job Application

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?

Yes

No

Are you currently authorized to work in the United States? *

(Proof of eligibility will be required if hired)

Yes

No

Have you ever been convicted of a crime/felony? *

Yes

No

Please describe offense:

Position applied for:

Wage desired:

Days/hours available to work:

Do you have a valid driver’s license?

Yes

No

Driver’s license #

State of issue

License expiration date

Do you have your own transportation?

Yes

No

If No, please describe means of transportation to and from work:

Can we contact your present/previous employer(s)?

Yes

No

Have you ever applied to, or worked for this company before?

Yes

No

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?

Yes

No

Education - College

Name of school

Address of college

# of years completed

Did you graduate?

Yes

No

Education - Trade School

Name of school

Address of college

# of years completed

Did you graduate?

Yes

No

Special skills or training:

Education - Military

Have you ever been in the Armed Forces?

Yes

No

If yes, which branch?

Rank held?

Date entered?

Discharge date?

Honorable discharge?

Yes

No

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 *

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 *

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

Reference phone number

Reference's employer

Reference #3

Reference full name

Reference's address

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: *