Automatic Products Co., Inc.

APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer

Fields in bold are required

(Application will remain active for 30 days)

Position Applied for:

Referral Source:

Last Name:

First Name:

M.I.:

Address	Street:		City:
Address	State:		Zip:

Phone Number

Email address:

Are you at least 18 years of age?

Yes No

Are you a U.S. Citizen or legally authorized to work in the U.S.

Yes No

Date you are able to start work:

May we conatct your current employer?

Yes No

Are you on layoff status or subject to recall elsewhere?

Yes No

Expected Pay:

per

If hired how long do you plan to continue working for the company?

Do you wish to work:

Full-time Part-time
Temporary

Are you willing and available to work?

On Call Days
Evenings Nights
Overtime
Weekends
Holidays

If applying for a job that requires one, do you have a valid driver's license?

Yes No

Do you smoke?

Yes No

Have you been conviceted of a felony or misdomeanor?*

Yes No

*A "yes" answer will not necessarily bar applicant from employment.

If so, explain

Have you previously applied with us?

Yes No

When

Have you previously worked with us?

Yes No

When

Are any of your records under a different name?

Yes No

If so, what name

Do you have any relatives working for us?

Yes No

If so, who

Is there any reason you might be unable to meet our attendance requirements?

Yes No

If yes, please explain

EDUCATION/ TRAINING	Name and Location of School	Did You Graduate?	Subjects Studied
High School		YesNo
College		YesNo
Other Training (particularly that led to license or certification)		YesNo

Are you taking or do you plan to take any additional eductaion? If so, what?

SKILLS / ABILITIES:

List any machines you are skilled in using:

List any skills or ablities you have which are pertinent to the position, including hobbies or related interests:

JOB REQUIREMENTS:

Will you be able to perform the essential functions of the job, with or without reasonable accommodation?

YesNo

PLEASE LIST WORK EXPERIENCE, INCLUDING MILTARY AND VOLUNTEER EXPERIENCE

Present or Last Employer:
Address:		Phone:

Start Date:		Leaving Date:
Supervisor:		Rate of Pay $
Job Title & Duties:
Why Did You Leave?

Previous Employer:
Address:		Phone:

Start Date:		Leaving Date:
Supervisor:		Rate of Pay $
Job Title & Duties:
Why Did You Leave?

Previous Employer:
Address:		Phone:

Start Date:		Leaving Date:
Supervisor:		Rate of Pay $
Job Title & Duties:
Why Did You Leave?

PERSONAL REFERENCES

Name:		Phone:
Address:
Occupation:		How Long Known:

Name:		Phone:
Address:
Occupation:		How Long Known:

PLEASE READ EACH OF THE FOLLWOING ITEMS BEFORE SUBMITTING THIS APPLICATION

As a final step in the hiring process, an applicant may be subject to an employment entrance exam that may include screening for illegal drugs. Applicants who confirm positive on drug screening will not be considered for employment. If a job offer is made, it may be made contingent upon the successful passing of a physical.
I CERTIFY that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, false, misleading or incomplete statements on this application shall be grounds for dismissal.
I AUTHORIZE the company to investigate information concerning my previous employment, education and background. I further release all parties from all liability for any damage that may result from furnishing or receiving such information.
I UNDERSTAND and agree that my employment and compensation may be terminated at any time without prior notice, with or without cause, at the option of the company or myself, and understand that no representative of the company, other than the President, has authority to enter into any agreement contrary to the foregoing.
I UNDERSTAND that all company property must be returned and any indebtedness to the company must be paid on or before my last day of work. I authorize the company to deduct from my final paycheck an amount necessary to satisfy any unpaid obligation.

I have read and understood the above clauses

YesNo

Note:

After successfully submitting the form you will be taken back to the Automatic Products home page.