Napoleon Spring Works Inc.
APPLICATION FOR EMPLOYMENT Date: //
All applicants will be considered for employment without regard to race, religion, color, sex, national origin, age, marital or veteran status, medical condition, handicap or disability, sexual orientation, citizenship status or any other status protected by law. We are an Equal Opportunity Employer.
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PERSONAL INFORMATION
Name:.
Last First Middle
Present Address:.
Street City State Zip Code
Permanent Address:.
Street City State Zip Code
Phone No.:.
Referred by: AdvertisementEmp. Agency Friend or Relative Walk In Website/Social Media
Are you 18 years of age or older? YES NO
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EMPLOYMENT DESIRED
Date You Salary
Position:Can Start: //Desired:
Have you worked for us before?YES NOIf “YES”, When and what department?.
List any special skills
.
MILITARY SERVICE
BRANCH OF SERVICE FROM TO RANK & DUTIES DATE DISCHARGED
EDUCATION Name and Location of School Last Year Did You Subjects Studied and
Completed Graduate? Degree(s) Received
High school 1 2 3 4 YES NO
College 1 2 3 4 YES NO
Trade, Business or 1 2 3 4 YES NO
Correspondence
School
Please see back side to finish application.
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Have you even been convicted of a crime (excluding misdemeanors and traffic offenses)? YES NO
If YES, list convictions:
(A conviction does not necessarily disqualify an applicant for the position being applied for. You are not obligated to disclose sealed or expunged records).
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FORMER EMPLOYERS List below your last four employers, starting with the last one first.
Date Salary
Month and Year Name and Address of Employer (upon leaving) Position Reason for Leaving
From:
To:
From:
To:
From:
To:
From:
To:
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PERSONAL REFERENCES List below three persons not related to you, whom you have known at least one year.
Name Address Phone Position Years Acquainted
AUTHORIZATION
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company.
I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me.
I understand and agree that if I am going to file a lawsuit against the Company, I need to do it within six (6) months of the alleged occurrence.
If I am offered employment I agree to submit to a medical examination and drug test before starting work. I consent to such examinations and tests, and I request that the examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated from my personnel file.
I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy. If I am hired by the Company, I will be required to attest to my identity and employment eligibility, and to present documents confirming my identity and employment eligibility. I understand that I cannot be hired if I cannot comply with these requirements.
Applicant Signature Date
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