Hodges Badge Company, Inc.

6440 Enduro Drive, Washington, MO 63090

APPLICATION FOR EMPLOYMENT

We are an equal opportunity employer and will consider all applicants for all positions without regard to race, color, religion, national origin, age, marital status, sex, sexual orientation, veteran status, disability,

or any other legally protected status.

PERSONAL DATA

Name:______

Present Address:______
Home Telephone # ______Cell # ______

How long at your present address?______Email ______

Position Applying For: ______Date Available:______

Salary Desired: $______/hr. or weekly

Are you seeking: Full Time ______Part Time _____ Temporary _____

Are you currently employed? Yes___ No___ If yes, may we contact your employer? Yes___ No___

Please indicate who referred you to us: Newspaper:______

Employee:______Agency:______School:______Walk-in______Other______

Please indicate family or friends employed here:______

Have you ever worked at our Company? Yes ____ No____ When?______

Have you applied for a position at our Company before? Yes ___ No___ If yes, when?______

If hired, can you provide proof of U.S. citizenship or eligibility to work in the U.S.? Yes ___ No___

(Federal law requires all employees to complete INS form I-9 and provide required documentation as a condition

of employment.)

If you are under 18 years of age and are hired, can you provide proof of eligibility to work legally in the US ? Yes _____ No _____

Prior U.S. Military Service: Yes _____ No _____

Training and duty while in service ______
EMPLOYMENT HISTORY: Starting with the most recent position, list the last 5 employers or at least 10 years of work experience, if applicable. Include work performed on a volunteer basis or job-related military service. Complete this section, in addition to providing a copy of your resume.

Company Name, Address, Phone &Fax number / Job Title & Salary / Supervisor’s Name & Title / Dates of Employment / Reason for Departure
1
2
3
4
5

Briefly describe duties for each position:

1.______

______

2.______

______

3.______

______

4.______

______

5. ______

______

GENERAL:

Language Skills: Speak ______Read ______Write ______

Computer Skills: Microsoft Office ____ Microsoft Excel ___ Microsoft Outlook ___ Microsoft Powerpoint ___ Other ______


EDUCATION

Name and Location of School / Number of Years Attended / Degree/Major/Minor Subjects Studied
High School or GED
Vocational School
College/University
Graduate School
Other

List any special skills, research or training that may be related to the job for which you are applying (such as technical, management or other related skills): ______

______

______

Describe any other experience or abilities you feel are beneficial and relevant to the position you have applied for: ______

______

______

REFERENCES: Please provide the names of at least 3 persons not related to you, whom you have known at least one year and who can attest to your credentials/accomplishments. Possible references to consider may be teachers or previous supervisors..

Name Address and Phone Number / Years Acquainted / Nature of Relationship
1
2
3


TO BE READ BY ALL APPLICANTS

Applicant Statement:

I HEREBY CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION (INCLUDING RESUME AND SUPPORTING DOCUMENTATION, IF APPLICABLE) ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL OR INELIGIBILITY FOR EMPLOYMENT.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship is of an “at will” nature, which means that employment may be terminated, with or without cause, and with or without notice, at any time, at the option of either the Company or the employee. It is further understood that this “at will” relationship many not be changed by any written document or conduct. As such, no representative of the Company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

I understand that Federal Law prohibits pre-employment screening based on medical history or condition, and prohibits a pre-employment inquiry about a history of workers’ compensation claims. I further understand that, if offered a position with Hodges Badge Company, Inc., I will be required to undergo a post-employment physical examination which will be related to the physical requirements of the position being offered. This examination will be paid for by Hodges Badge Company, Inc.. I also understand that, if hired, I may be required to undergo a physical examination and/or drug/alcohol testing if I become involved in an accident during the course of work, on or off the premises, in a company vehicle, or if a reasonable suspicion of drug or alcohol use exists based on my performance, appearance, and and/or behavior.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY OTHER PERTINENT INFORMATION THESE REFERENCES MAY HAVE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING INFORMATION TO YOU.

I understand that in the event of employment, I am required to abide by all rules and regulations of HODGES BADGE COMPANY, INC.

I acknowledge that I have read this application for employment, requirements, and authorization and fully understand its contents and voluntarily agree to its provisions.

______

Date Printed Name Signature of Applicant

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This application for employment shall be considered active for a period of time not to exceed 6 months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

Revised 5/19/2017 LW