Tell Us About You

First name

Last name

Phone number

Best time to contact

Have you been known by any other name(s)?

Yes

If yes, state name(s):

Are you at least 18 years of age?

Yes

Email*

Street address

City

State/Region

Zip Code

How long have you lived at this address?

Are you legally eligible to work in the United States?

Federal immigration laws require all job applicants to provide, if hired, appropriate identity and employment eligibility documents within three days of hire, and if hired, thereafter where necessary to demonstrate continued compliance with the immigration laws.

Yes

Do you have restrictions on the hours you would be available to work?

Yes

If yes, please explain:

What position are you applying for?

Date available to begin work:

Year/Month/Day

What skills and abilities do you have that qualify you for this position?

Such as special equipment or machines you can operate, computer software you can operate, or other relevant skills.

List special accomplishments, publications, awards.

Exclude information which would reveal sex, race, religion, national, origin, age, ancestry, disability, or other protected status.

Are you able to perform the job functions specified?

Yes

Have you been employed by Allied Moulded before?

Yes

If yes, give dates of employment and position(s) held:

Friends or relatives employed by Allied Moulded Products, Inc.?

Please identify them.

How did you hear about the company/position?

Are you on a layoff and/or subject to recall? Please explain.

Do you have a reliable means of transportation to enable you to get to work in a timely manner?

Yes

Education & Other Information

High School

College

Years Completed

Other

Employment History

Employer 1

Employer 1*

Company Name

Telephone (Employer 1)

Company Phone Number

Address (Employer 1)

Position (Employer 1)*

Dates Employed (Employer 1)*

From/To

Immediate Supervisor and Title (Employer 1)

Reason for leaving (Employer 1)*

May we contact for reference? (Employer 1)*

Yes

Later

Will you receive a satisfactory reference from (employer 1)?*

Yes

If "No", please explain: (Employer 1)

Summarize the nature of the work performed and job responsibilities. (Employer 1)*

Employer 2

Employer 2*

Company Name

Telephone (Employer 2)

Company Phone Number

Address (Employer 2)

Position (Employer 2)*

Dates Employed (Employer 2)*

From/To

Immediate Supervisor and Title (Employer 2)

Reason for leaving (Employer 2)*

May we contact for reference? (Employer 2)*

Yes

Later

Will you receive a satisfactory reference from (employer 2)?*

Yes

If "No", please explain: (Employer 2)

Summarize the nature of the work performed and job responsibilities. (Employer 2)*

Employer 3

*Employer 3

Company Name

Telephone (Employer 3)

Company Telephone Number

Address (Employer 3)

Position (Employer 3)

Dates Employed (Employer 3)

From/To

Immediate Supervisor and Title (Employer 3)

Reason for leaving (Employer 3)

May we contact for reference? (Employer 3)

Yes

Will you receive a satisfactory reference from (employer 3)?

Yes

If "No", please explain: (Employer 3)

Summarize the nature of the work performed and job responsibilities. (Employer 3)

Have you ever been disciplined or discharged from a previous job?*

Yes

If yes, please explain

References

Reference 1 - Name*

Reference 1 - Telephone*

Reference 1 - Years Known*

Reference 2 - Name

Reference 2 - Telephone

Reference 2 - Years Known

Reference 3 - Name

Reference 3 - Telephone

Reference 3 - Years Known

IMPORTANT- READ CAREFULLY BEFORE SUBMITTING THIS APPLICATION
Allied Moulded Products, Inc. expresses its appreciation for the time and effort you have spent in completing this application. Please check your application to insure that you have completely and accurately answered every question.
Your application is contingent upon your agreement to the following statement. Your signature below will indicate that you have read this statement and agree to its terms:

I certify that I have provided information that, to the best of my knowledge, is truthful and accurate. I understand that deliberate falsifications or significant omissions will be grounds for denying or terminating employment with Allied Moulded Products, Inc.

I agree to allow Allied Moulded Products, Inc. to contact the people/employers I have listed on this applrcation. I also agree not to hold any references or employers listed on this application liable for damages relating to any truthful information they provide regarding my qualifications for employment at Allied Moulded Products, Inc.

Allied Moulded Products, Inc. maintains a drug-free workplace. All applicants for this position must undergo a pre employment drug screening at Allied's expense. Applicants testing positive for illegal substances will be disqualified from consideration. Upon hire, employees will be expected to abide by the company's drug policy.

To comply with the federal Immigration Reform and ·Control Act, Allied Moulded Products, Inc. requires all new hires to show proof of their eligibility to work in the United States. Failure to produce the required documents will cause Allied to withdraw its job offer and terminate an individual's employment.

I understand that nothing in this application creates an employment contract or relationship. I also understand that if hired by Allied, my employment can be terminated at any time, by myself or Allied, for any grounds not prohibited by law.

I understand that no one, other than the President of Allied, has any authority to enter into any agreement of employment for any specified period of time, or to make any agreement contrary to the foregoing. I understand that any such agreement by the President may only be done in writing signed by them.

If hired by Allied Moulded Products, Inc. I will carry out my job duties in an ethical manner and avoid any conflicts of interest. I understand that performing services for any competitor or disclosing confidential company information to people outside Allied Moulded Products, Inc. will be grounds for terminating my employment with Allied Moulded Products, Inc.

I understand that if hired, I may be required to sign an agreement consenting to assign to Allied Moulded Products, Inc. the rights to any inventions, original works, discoveries, ideas, and improvements arising out of my employment with Allied Moulded Products, Inc.

This application is current for only sixty (60) days. At the conclusion of this time, if I have not heard from Allied Moulded Products, Inc. and still wish to be considered for employment, it will be necessary for me to complete a new application for employment.

I further understand that this is an application for employment and that no offer of employment is being made at this time.

I understand/agree to the above statements and wish to submit my application.*