Application for Employment
Rubberlite, Inc. is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.
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| Personal: |
| First Name | |
| Last Name | |
| Middle Name | |
| Address 1 | |
| Address 2 | |
| City | |
| State | |
| Zip | |
| Position Sought | |
| What shift? | |
| Date Available (mm/dd/yyy) | // |
| Salary Desired | |
| Phone Number | |
| Cell Number | |
| Over 18 Years Old? | |
| Are you legally eligible for employment in the United States? | |
| (If offered employment, you will be required to provide documentation to verify eligibility.) |
| Have you applied at Rubberlite before? | |
| If yes, when? | |
| Do you have adequate Transportation to and from work? | |
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| Education: Please indicate education or training which you believe qualifies you for the position you are seeking. |
| High School: Number of Years Completed | 1 2 3 4 |
| Diploma | |
| G.E.D. | |
| College/Vocational School: Number of Years Completed | 1 2 3 4 |
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| School | |
| City/State | |
| Major | |
| Degree Earned | |
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| School | |
| City/State | |
| Major | |
| Degree Earned | |
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| Other Training or Degrees |
| School | |
| City/State | |
| Major | |
| Degree Earned | |
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| Professional License or Membership: Type of License(s) Held | |
| License Expiration Date | |
| Other Professional Memberships | |
| (You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status.) |
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| Have you ever been employed by Rubberlite, Inc. | |
| If yes, when? | |
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| Record of Conviction: |
| During the last ten years, have you ever been convicted of a crime other than a minor traffic offense? | |
| If yes, explain | |
| (A conviction will not automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and relevance to open position will be considered.) |
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| Employment: List last employer first, including U.S. Military Service. |
| May we contact your present employer? | |
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| If any employment was under a different name, indicate name | |
| Employer | |
| Address | |
| Telephone | |
| Position | |
| Started Employment (mm/yyy) | / |
| Ended Employment (mm/yyy) | / |
| Salary | |
| Supervisor | |
| Reason for Leaving | |
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| If any employment was under a different name, indicate name | |
| Employer | |
| Address | |
| Telephone | |
| Position | |
| Started Employment (mm/yyy) | / |
| Ended Employment (mm/yyy) | / |
| Salary | |
| Supervisor | |
| Reason for Leaving | |
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| If any employment was under a different name, indicate name | |
| Employer | |
| Address | |
| Telephone | |
| Position | |
| Started Employment (mm/yyy) | / |
| Ended Employment (mm/yyy) | / |
| Salary | |
| Supervisor | |
| Reason for Leaving | |
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Applicant's Certification:
I hereby affirm that the information provided on this application is true and complete to the best of my knowledge. I also agree that falsified or omitted information may disqualify me from further consideration from employment and may be considered justification for dismissal if discovered at a later date.
I understand that if I am employed by Rubberlite, Inc. my employment can be terminated, with or without cause, at any time at the discretion of either Rubberlite, Inc. or by me. I understand that no management official, except as authorized in writing by the Board of Directors of Rubberlite, Inc. has any authority to enter into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment. Any contractual agreement authorized by the Board of Directors will be in writing and duly signed.
I authorize persons, schools, my current employer, if applicable, previous employers, organizations, and references named in this application to provide any relevant information that may be required to arrive at any employment decision, and I expressly authorize Rubberlite, Inc. to contact any of these for such purposes. I also expressly release those above authorized from any and all employment liability and will supply additional authorizations and releases as may be deemed necessary to assist in arriving at any employment decision.
I further agree that if I am employed by Rubberlite, Inc. that I will abide and comply with all of Rubberlite, Inc.’s rules and regulations, unless otherwise specifically agreed to in writing. I also understand and agree that any employment rules, regulations, handbooks, guidelines, manuals, or policies that may be distributed or given to me during such employment with Rubberlite, Inc. shall be subject to change at the discretion of Rubberlite, Inc. and shall not be construed as a contract.
I understand that continued employment is contingent upon providing proof of employment eligibility under immigration laws and regulations.
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| I Agree to the above certification | |
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| This application will be on file for six (6) months from the date received. Thank you for your interest in employment with our Company. |
