Employment Application

POSITION APPLIED FOR:


DATE:
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Application for Employment

(Pre-Employment Questionnaire)

We are an equal opportunity employer, dedicated to a policy of non-discrimination. Employment is based upon qualification, without regard to race, sex, religion, marital status, color, age, or national origin, veteran’s status, disability, status with regard to public assistance, and any other status protected by law.

PLEASE COMPLETE ALL INFORMATION EVEN IF INCLUDED IN YOUR RESUME.

PERSONAL DATA






Middle Initial


Present Number/Street City State Zip Area Code/Telephone Address:

Permanent Number/Street City State Zip Area Code/Telephone Address:

Other Name(s) by which applicant is known to references if different from present name:

Do you have any relatives working at (Company)? Yes No If yes, Name(s) & Relationship:

Salary Desired:

When are you available for employment?

Are you under 18:


How did you hear of us?




Person


Other

Please check the positions you are interested in:


Full-time Part-time


Either

Please check days and hours you are available for work:

SU


















Are you authorized to work in the United States?

If yes, proof of identity and employment eligibility will be required upon beginning employment.

EDUCATION: Education is a criterion that the company may utilize in determining whether or not an applicant is qualified.

Name and Location of School

Degree or Certification Received

Course of Major/Minor Subjects

No. of Years Attended

High School (or G.E.D.)

College or University

Business, Trade or Technical Schools

Military Service Schools

 

WORK EXPERIENCE Please account for all periods of employment. Start with your most recent position and include include military service. You may attach a resume to supplement information, but application must be completed in full.

Present or Last Position

NAME OF EMPLOYER






Date Started

Starting Earnings

$ Per wk/mo.


May we call you at this number?

Date Ended

Present (Last) Earnings

$ Per wk/mo.


May we contact your present employer prior to any offer?

Name and Title of Present (Last) Supervisor

Reason for Leaving?

Brief description of your responsibilities (Include number of employees you supervised, if applicable)

 

NAME OF EMPLOYER






Date Started

Starting Earnings

$ Per wk/mo.


May we call you at this number?

Date Ended

Present (Last) Earnings

$ Per wk/mo.


May we contact your present employer prior to any offer?

Name and Title of Present (Last) Supervisor

Reason for Leaving?

Brief description of your responsibilities (Include number of employees you supervised, if applicable)

 

NAME OF EMPLOYER






Date Started

Starting Earnings

$ Per wk/mo.


May we call you at this number?

Date Ended

Present (Last) Earnings

$ Per wk/mo.


May we contact your present employer prior to any offer?

Name and Title of Present (Last) Supervisor

Reason for Leaving?

Brief description of your responsibilities (Include number of employees you supervised, if applicable)

 

NAME OF EMPLOYER






Date Started

Starting Earnings

$ Per wk/mo.


May we call you at this number?

Date Ended

Present (Last) Earnings

$ Per wk/mo.


May we contact your present employer prior to any offer?

Name and Title of Present (Last) Supervisor

Reason for Leaving?

Brief description of your responsibilities (Include number of employees you supervised, if applicable)

 

NAME OF EMPLOYER






Date Started

Starting Earnings

$ Per wk/mo.


May we call you at this number?

Date Ended

Present (Last) Earnings

$ Per wk/mo.


May we contact your present employer prior to any offer?

Name and Title of Present (Last) Supervisor

Reason for Leaving?

Brief description of your responsibilities (Include number of employees you supervised, if applicable)

 

NAME OF EMPLOYER






Date Started

Starting Earnings

$ Per wk/mo.


May we call you at this number?

Date Ended

Present (Last) Earnings

$ Per wk/mo.


May we contact your present employer prior to any offer?

Name and Title of Present (Last) Supervisor

Reason for Leaving?

Brief description of your responsibilities (Include number of employees you supervised, if applicable)

PROFESSIONAL REFERENCES (Former Employers and/or Business Associates)

Name Address Phone

1.



2..



3..



APPLICANT: Please read carefully and sign

I affirm that the information provided is true and complete and that I have not withheld any fact(s). Any misrepresentation, falsification, omission or derogatory information that is discovered may prevent my being hired, or if hired, may subject me to disciplinary action, up to and including immediate employment dismissal.

I authorize American Carton & Polybag or its agents to conduct an investigation and verification of all statements and information contained in this application that the Company may deem relevant to evaluating my qualifications for employment. I authorize all my previous employers or other persons having information concerning me or my record of employment to report such information to American Carton & Polybag, Inc. I release each such person, American Carton & Polybag and its agents from all claims and liability whatsoever arising out of such an investigation and disclosure of my background. American Carton & Polybag will seek to keep all such information confidential except where such information is required to be released by law.

Upon receiving a conditional offer of employment, I agree to submit to a physical examination by a doctor or facility designated by and at the expense of American Carton & Polybag. I understand that refusal to submit to such a physical examination may result in the withdrawal of an employment offer or my dismissal. Further, I agree to the release of relevant medical information to authorized American Carton & Polybag representatives. I also agree that my employment with American Carton & Polybag is contingent upon passing such physical examination as determined by American Carton & Polybag.

I understand that this is an application for employment and that no employment contract is being offered. I also understand that, if offered employment, I will be an at-will employee of American Carton & Polybag which means that my employment can be terminated at any time for any reason, with or without notice, at the option of either the Company or myself. No representative of American Carton & Polybag has any authority to make any representation to the contrary.

I have read, understand and agree to the above.