J & J Manufacturing Company, Inc

STRONGARM INDUSTRIES, INC.

An Equal Opportunity Employer

Application for Employment

Identification

Name ( ) / Social Security Number - -
Last First Middle Any Prior Last Name
Current Address / Phone
Street Number City State Zip / Home Other
U.S. Citizen Yes No
Notify in case of emergency Name Relationship Address Phone

Job Interest

Position(s) Desired / Are you employed now Yes No
Salary or wage requirement / Date available
Date of Birth
Do you have any physical handicaps? Yes No
If yes, please describe
Have you ever been
convicted of, or entered a plea of guilty to, a felony? / Yes If yes, when, where, nature of offense, disposition
No

Education

Schools / City and State / Dates Attended
From To / Graduate? / Major Courses / Specific Degree Received
High School
College
Graduate, technical, business schools
Grade average High School College Other (If point system, “A” average = )
Scholastic honors or scholarships received
Technical or professional affiliations
Are you now continuing your education? Yes No If yes, how and where

U.S. Military Service

Entry Date / Branch / Rank or Rate
Entry Discharge / Period of Active Duty
From To / Present Draft Status / Active Duty Requirement if any
Special training received in service
Name and address of the employer you left to enter the service

References

Give names of people who have known you during the past two years.
Name / Relationship / Occupation / Address

Employment (List current or most recent employer first)

Employer / Position
Address / Nature of duties
Wage or salary / Other compensation
Phone / Supervisor
Date employed / Start / End / Reason for leaving
Employer / Position
Address / Nature of duties
Wage or salary / Other compensation
Phone / Supervisor
Date employed / Start / End / Reason for leaving
Employer / Position
Address / Nature of duties
Wage or salary / Other compensation
Phone / Supervisor
Date employed / Start / End / Reason for leaving
Employer / Position
Address / Nature of duties
Wage or salary / Other compensation
Phone / Supervisor
Date employed / Start / End / Reason for leaving
Describe the experiences you have had which particularly qualify you for the position(s) in which you are interested.
Check the office skills in which you have had training or experience:
Typing / Stenography / Word Processing / Keypunching / Other
Word per minute / Stenographic______/ Typing______

Employment Statement

In completing and submitting this application. I understand and agree that falsification or concealment of facts made during the application process will result in discharge when discovered. That my signature authorizes the Corporation to investigate all such facts and statements presented here or during such process. That my previous employers, my references, and the schools I have attended may be asked for information concerning my employment, ability, and experience. That my employment will be subject to satisfactory completion of a physical examination by a physician designated by the Corporation prior to employment and at such time as may be required by the company. That if I am hired, I will abide by the rules and policies of the Corporation (none of which constitute any / representation or promise of continued employment); That, if I am hired. I shall not, directly or indirectly, other than in the business of the Corporation or any of its subsidiaries or affiliates and in the scope of my employment disclosure or use at any time (either during or subsequent to my said employment) any information, knowledge, or data of the Corporation or any of its subsidiaries or affiliates, which is of a secret or confidential nature, unless I shall secure the prior written consent of the Corporation; That only written representations and promises of the Corporation are enforceable; That my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at my option or the option of the Corporation.
Date of Application______/ Signature______