Please Use Black Ink Or Type. Print Clearly and Sign This Application on the Last Page

Employment Application

Please use black ink or type. Print clearly and sign this application on the last page.

Last Name / First Name / Middle Name / U.S. Social Security No.
Street Address / City and State / Zip / Home Telephone
Cell Phone / Best time to contact you
Email Address

DO YOU HAVE A LEGAL RIGHT TO WORK IN THE U.S.?  YES  NO If no, stop the application process here.

Note: If you are offered employment you will be required to furnish proof of U.S. Citizenship or your authorization to work in the U.S. as specified by the E-Verify Program of the U.S.

1)Have you ever been convicted of a felony (including a plea of “no contest”) under your current name or any other name? (Note: CoLinx does not employ convicted felons)

Please insert the word YES or NO______if yes, stop here.

2)Have you been convicted within the past seven years of a misdemeanor resulting in incarceration? (Note: Misdemeanor conviction does not necessarily prevent employment.)

Please insert the word YES or NO______

If yes to 2 above, fill in the following:

Date / Name / Court / Nature of Offense / Disposition

Describe the type of employment you desire.

______ Full Time

 Part Time

______ Co-Op

Are you 18 years of age or older?  Yes  No Summer Intern

Please indicate source of referral to CoLinx Please Specify Source:

 Contacted CoLinx on Own CoLinx Employee State Employment Agency

 Career Fair Print Advertising Search Firm

 University Recruiting Internet Site Other

If referred by a CoLinx employee, please indicate your relationship to the employee:

______

Printed Name of CoLinx Employee ______

Signature of CoLinx Employee ______

Have you worked for CoLinx in the past?  Yes  No

If yes, please indicate your name at that time.

Name / Location / Date

Do you have any friends or relatives working at CoLinx?

Yes  No Please list below.

Name / Relationship
Name / Relationship
Name / Relationship

Formal Education

High School/GEDLocationDid you graduate?

 Yes  No

University

Institution Name, City/State / Degree / Major/Areas of Concentration / Overall GPA (e.g. 3.2/4.0) / Units Completed / Did you graduate?

OTHER EDUCATION (TRADE/TECHNICAL)

Institution Name, City/State / Major/Areas of Concentration / Did you complete?

Employment History

Beginning with the most recent, list your last four jobs, including temporary positions, part-time employment while in school, U.S. military service, and self-employment. A resume is not a substitute for completing this section.

* Base pay is your basic rate of pay excluding overtime pay, special bonuses, allowances, or shift premium.

** Other compensation includes variable pay like overtime, bonus, commissions, shift differential, etc.

*** To list additional employers please attach supplemental pages if desired.

Employer / Telephone Number / Street, Address, City, State, Zip
Manager (Name and Title) / Telephone Number / Your Job Title
Description of Duties / From (Mo/Yr) / To (Mo/Yr)
Base Rate*
$ per
Reason for Leaving (Please be specific) / Other Compensation**
Employer / Telephone Number / Street, Address, City, State, Zip
Manager (Name and Title) / Telephone Number / Your Job Title
Description of Duties / From (Mo/Yr) / To (Mo/Yr)
Base Rate*
$ per
Reason for Leaving (Please be specific) / Other Compensation**
Employer / Telephone Number / Street, Address, City, State, Zip
Manager (Name and Title) / Telephone Number / Your Job Title
Description of Duties / From (Mo/Yr) / To (Mo/Yr)
Base Rate*
$ per
Reason for Leaving (Please be specific) / Other Compensation**
Employer / Telephone Number / Street, Address, City, State, Zip
Manager (Name and Title) / Telephone Number / Your Job Title
Description of Duties / From (Mo/Yr) / To (Mo/Yr)
Base Rate*
$ per
Reason for Leaving (Please be specific) / Other Compensation**

Unemployment Periods

Please list any periods of unemployment (up to four) that lasted one month or more between schooling, military, or employed periods. Include periods of time with dates, and the reason for unemployment.

From (Mo/Yr) / To (Mo/Yr) / Reason for Unemployment

Professional Memberships

List scientific, business, engineering, or industry societies or associations you have belonged to during the past ten years. (You may exclude those that indicate age, race, color, religion, sex, national origin, ancestry, or disability.)

Professional References

List three persons familiar with your previous work that we may contact, excluding relatives.

Name (Last, First, Middle) / Working Relationship/Association / Home Phone Number / Work Phone Number

Special Skills

Name any precision gauges (micrometer, etc.) you can use
Can you read and work from blueprints?  Yes  No
Do you object to operating machinery?  Yes  No
Which shift(s) will you work?
 1st  2nd  3rd
Are you : Right Handed  Left Handed
Date you can start work
List any special skills or occupations you have which would especially qualify you to work for CoLinx
List machines you can operate / List machines you can set up

Clearances

Have you ever had a security clearance?  Yes  No
If yes, give name of employer, clearance level, and inclusive dates below: / Have you ever had a security clearance suspended, denied, or revoked?  Yes  No If yes explain below:

U.S. Military Service/Government Service

Service Branch / Government Agency / Initial Rank or GS Grade / From (Mo/Yr) To (Mo/Yr) / Final Rank or GS Grade
Military Specialty / Training Received:
Reserves:  Yes  No / Retired:  Yes  No / If you served in either the U.S. military or government service as a civilian employee, please explain:

• I certify that the information that I have provided in this employment application is a true and complete response to each question asked. I acknowledge that I have given careful consideration to each question and had the opportunity to ask for clarification prior to responding.
• I authorize CoLinx and/or any of its agents to verify the accuracy and completeness of any and all the information that I have provided.
• I authorize my former employers and educational institutions to provide CoLinx with any information that they may have about myself, and I absolve them from any damages in providing such information.
• I understand that this application is for employment of indefinite duration that can be terminated with or without cause and notice at any time, either by CoLinx or me. I understand that no member of management, official or agent of CoLinx has authority to make any agreement (oral, written, or implied) or other representations to the contrary.
• I agree that employment is contingent on passing a drug-screening test, as defined by current CoLinx policy.
• I agree to provide a copy of my most recent pay stub and W-2 statement as proof of my salary and total earnings, and evidence of my educational degree(s) upon request.
• I acknowledge and agree that if, upon investigation, anything in this application is found to be untrue; I will be subject to dismissal at any time during my employment with CoLinx.
• I understand and agree that a facsimile or electronic copy of my signature will be considered as binding as my original signature.

As an Equal Opportunity Employer, we appreciate your interest in CoLinx, LLC.

APPLICANT – PLEASE SIGN AND DATE BELOW

SignatureDate

Submit your completed applicationto via email to or fax to 931-459-5301 or mail or hand deliver to 1536 Genesis Road, Crossville TN 38555

CoLinx participates in the E-Verify Program as determined by the U.S. Department of Homeland Security (DHS) and the U.S. Social Security Administration. For more information about E-Verify, phone DHS at 888-464-4218. You will be required to produce legal identification as part of the hiring process.

In order to comply with reporting requirements under Federal Law regarding the number of people who apply at our company by gender and ethnic group, we ask that you please complete this form. The information you are asked to provide will be used solely for purposes of compliance with legal requirements and will not be used in making an employment decision. Completion of this page is voluntary.

WHITE (Not of Hispanic Origin)

Includes persons having origins in any of the original peoples of Europe, North Africa or the Middle East.

BLACK OR AFRICAN AMERICAN (Not of Hispanic Origin)

All persons having origins in any of the Black racial groups.

ASIAN

All persons having origins in any of the original peoples of the Far East, Southeast Asia, Indian Subcontinent. This area includes, for example, China, Japan, Korea, the Philippine Islands and India.

NATIVE HAWAIIAN OR PACIFIC ISLANDERS

All persons having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.

AMERICAN INDIAN OR ALASKAN NATIVE

Persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

HISPANIC OR LATINO

All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin.

TWO OR MORE RACES

All persons who identify with more than one of the six races.

GENDERFEMALEMALE

Printed Name: Signature:

CoLinx, LLC is an Equal Opportunity Employer

Pre-Employment Drug Testing Consent and Release Form

I hereby consent to submit to urinalysis and/or other test as shall be determined by CoLinx in the selection process of applicants for employment, for the purpose of determining the drug content thereof.

I agree the independent drug testing company designated by CoLinx or their representative may collect these specimens from me for these tests and may test them or forward them to a testing laboratory designated by the company for analysis.

I further agree to and hereby authorize the release of the results of said tests to CoLinx.

I understand that use of illegal substances and/or abuse of alcohol will prohibit me from being employed by CoLinx.

I further agree to hold harmless CoLinx and its agents (including the above named designated 3rd party medical practice or clinic) from any liability arising in whole or part out of the collection of specimens, testing and use of the information from said testing in connection with the Company’s consideration of my employment application.

I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.

I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part and I have not been coerced into signing this document by anyone.

Applicant:

Print Name ______S.S.#: ______-______-______

Applicant:

Signature ______Date: ______/______/______

Witness Printed Name: ______

Witness Signature: ______Date