Pittgrove , NJ 08318
APPLICATION FOR EMPLOYMENT
We consider applicants for all positions
without regard to race, color, religion, sex, national origin, age, marital or
veteran status, the presence of a non-job-related medical condition or
handicap, or any other legally protected status.
This is a non-smoking
environment
PERSONAL
INFORMATION
Name ____________________________________________________________________________________________
Last First Middle
Present
Address_____________________________________________________________________________________
Street City Zip Phone
Permanent
Address __________________________________________________________________________________
Street City Zip Phone
List
any relatives working for us:
_______________________________________________________________________
_________________________________________________________________________________________________
How
did you learn about Phoenix Glass?
Newpaper Ad ________________________________________ Referred by ___________________________________
Other
_____________________________________________________________________________________________
________________________________________________________________________________________________________________________
EMPLOYMENT DESIRED
Position
_____________________________________ Date
you can start? ____________________________________
Are
you employed now? ________________________ If so, may we inquire of your present employer?
_____________
Are
you 18 years of age or older? Yes
____________________________ No
_____________________________
Have
you applied for a job at PHOENIX GLASS before? Yes
________________ No
________________
If yes, when?
_____________________________________________________________________________________
EDUCATION
|
|
Name
& Location of School |
No of Yrs. Attended |
Did You Graduate? |
Major Course of Study |
|
High
School |
|
|
|
|
|
College |
|
|
|
|
|
Trade,
Business, or Correspondence
School |
|
|
|
|
Please describe
additional skills, training, or ability you would like to have us consider in
evaluating your qualifications:
________________________________________________________________________________________________
PC
Skills:
________________________________________________________________________________________
________________________________________________________________________________________________
FORMER EMPLOYERS ( List below last three employers, starting with current
employer)
|
Company Firm: ___________________________ Address:_________________________________ ________________________________________ Phone: __________________________________ Supervisor: ______________________________ |
Mo./Yr. From: To: Rate
of Pay: Start: Finish: |
Job
Title: _____________________________ Duties:
_______________________________ Reason
for Leaving: ____________________ |
|
Company Firm: ___________________________ Address:_________________________________ ________________________________________ Phone: __________________________________ Supervisor: ______________________________ |
Mo./Yr. From: To: Rate
of Pay: Start: Finish: |
Job Title:
_____________________________ Duties:
_______________________________ Reason
for Leaving: ____________________ |
|
Company Firm: ___________________________ Address: ________________________________ ________________________________________ Phone: __________________________________ Supervisor: ______________________________ |
Mo./Yr. From: To: Rate
of Pay: Start: Finish: |
Job
Title: _____________________________ Duties: _______________________________ Reason for Leaving: ____________________ |
REFERENCES (Give the names of three
persons not related to you whom you have know at least one year)
__________________________________________________________________________________________________
Name Address Phone No. Occupation Years
Aquainted
__________________________________________________________________________________________________
Name Address Phone No. Occupation Years
Aquainted
__________________________________________________________________________________________________
Name Address Phone No. Occupation Years
Acquainted
Are you able, with
or without accommodation, to perform all of the functions of the job for which
you are applying?
Yes
____________________ No
____________________
U.S.
Dates
of Service: From
_________________ To ___________________ Branch
_________________
Rank
and Principal Duties:
____________________________________________________________________________
_________________________________________________________________________________________________
Type
of Discharge: __________________________________________________________________________________
OTHER
Are
you a
If
not, are you an alien lawfully authorized to work in the
Have
you been convicted of a felony within the last 7 years? Yes ___________ No __________
(Conviction
will not necessarily disqualify an applicant from employment.)
If
“yes” please explain
_______________________________________________________________________________
__________________________________________________________________________________________________
I hereby give
PHOENIX GLASS the right to make a thorough investigation into my previous
employment, education and references; and I release from all liability all
persons, companies, and corporations supplying such information. I release, indemnify, and hold harmless
PHOENIX GLASS from and against any and all liability which might result from making
such an investigation.
I
understand that any false answer, statement, or representation made by me in
this application shall constitute sufficient cause for discharge. I also understand that nothing contained in
this employment application or granting of an interview is intended to create
an employment contract between PHOENIX GLASS and myself for either employment
or for the granting of benefits. No
promises regarding employment have been made to me, and I understand that no
such promise or guarantee is binding upon PHOENIX GLASS unless made in
writing. If an employment relationship
is established, I understand and agree that it is not for a definite period of
time and that I have the right to terminate my employment at any time and that
PHOENIX GLASS retains a similar right.
I
understand that, if accepted for employment, it is necessary to abide by the
rules and policies of PHOENIX GLASS.
Date:
_______________________________________ Signature:
___________________________________________