Application - Waukesha Metal Products

Name

First Middle Initial Last

Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Date Available

Desired Salary

Position Applied for:

Shift Preference

1st

2nd

Weekend

Are you a citizen of the United States?

Yes

No

If no, are you authorized to work in the U.S.?

Yes

No

Have you ever worked for this company?

Yes

No

If so, when?

Have you ever been convicted of a crime or criminal offense (excluding minor traffic violations)?

Exclude any sealed or expunged convictions. Disclosure of a criminal record will not necessarily disqualify you for employment. Each conviction will be evaluated on its own merits with respect to time, circumstances and seriousness, in relation to the position for which you are applying. However, failure to disclose such information may result in disqualification of your application or, if hired, termination of your employment.

Yes

No

If your answer was "YES", please explain:

Do you have any pending criminal charges against you?

Yes

No

If yes, please explain:

If required to drive a vehicle for the job applying for, do you have a valid driver's license?

Yes

No

Issuing State

State / Province / Region Country

Are you at least 18 years old?

Yes

No

If no, employment will be subject to state/federal age requirements and you will need to furnish a work permit.

How were you referred to the company?

Agency

Walk-In

Newspaper

Present Employee

If Present Employee, please enter their name.

First Last

High School

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years Completed:

Did you graduate?

Yes

No

Diploma/Degree

College

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years Completed:

Did you graduate?

Yes

No

Diploma/Degree

Other

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years Completed:

Did you graduate?

Yes

No

Diploma/Degree

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

First Last

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

First Last

Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

First Last

Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

First Last

Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

No

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain:

I certify that the information contained in this application is correct to the best of my knowledge. I understand that, if hired for employment, any misstatement or omission of information on this application will be grounds for immediate termination. I hereby authorize Waukesha Metal Products to conduct an investigation of all statements contained in this application, including my response to the inquiry concerning any criminal conviction record, and understand that my employment is contingent upon satisfactory completion of such investigation. I further authorize the employers listed herein to give Waukesha Metal Products (the “Company”) any and all information concerning my previous employment and any pertinent information they may have, personal and otherwise, and I release all parties from liability for any damage that may result from furnishing that information to the Company. I understand that if I am offered a job position, I will be required, as a condition of employment, to submit to a physical exam and/or drug screening. I authorize Waukesha Metal Products to obtain a consumer report or an investigative consumer report concerning my background and credit and I understand that such report may be used as part of the process in considering my candidacy for employment. Pursuant to the Immigration Reform and Control Act of 1986, all applicants, upon being made an offer of employment, must produce documents, which are specified by the federal government, establishing their identity and authorization for employment in the United States. These documents must be produced no later than seventy-two hours after commencement. I understand that I will also be required to sign a Form I-9 (issued by the federal government) verifying, under oath, my employment authorization. I understand that, if I am hired, my employment shall be “at will” and can be terminated by the Company or me with or without cause, at any time, with or without notice. I further understand that, if I am hired, the terms and conditions of my employment, including compensation and benefits, can be changed at the discretion of the Company, upon notice to me. However, any alteration of the “at will” status of my employment or terms and conditions of my employment must be made in a written employment agreement signed by me and by the President/CEO of Waukesha Metal Products.

Type Name

Date

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