Form

Employment Application

The careful, truthful, and thoughtful completion of this application is an important step in our consideration of individuals for employment. Therefore, you must complete the entire application. If you do not, you will not be considered for employment.

Your application will go into our inactive file one year from the date of application. If after the one year period you wish to remain on the Company’s active applicant status, please contact Haviland’s Human Resources department.

We are an equal opportunity employer which means that we afford equal employment opportunity regardless of a person’s age, race, religion, color, national origin, gender, marital status, height, weight, qualifying disability, genetics, veteran status, or any other characteristic protected by law.

Are you 18 or older?

Contact Information

First name*

Middle Initial

Last name*

Adress:*

State:*

City:*

Zip:*

Cell Phone:*

Other Phone:

Email:*

Job Information

Position Applied For:*

If you selected other, please list the position title:

Are you presently employed:*

If you are currently employed, what position are you working?

Packaging Experience:

Highest Level of Education*

Years of Packaging Experience:

High-Lo Experience:

Years of Hi-Lo Experience:

Salary Expected:

Resume:

General Information

Are you familiar with the essential requirements of the job for which you are applying? *

Are you able to perform the essential requirements of the job with or without reasonable accommodation? *

Have you ever been convicted of a crime? *

Are there any felony charges pending against you? *

Applicant Statement

Application Statement
(You Must Date and Sign This Applicant Statement To Be Considered For Employment)

AFFIRMATION. I affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I also agree that any false information, misrepresentation, or omissions may disqualify me from further consideration for employment and may result in termination of my employment if discovered at a later date.

AUTHORIZATION. I authorize the Company to investigate all statements contained in this application, to contact my previous employers, to contact education institutions I attended, and to discuss with them my employment/education history with them. I authorize my former employers and any educational institutions I have attended to disclose and discuss my employment/education history and records, including my disciplinary records, and waive any right to notice of such disclosure or discussion.

EXAMINATIONS. Should I receive a conditional offer of employment, I agree to submit to any physical, medical and/or psychological examination. I further authorize any physician, counselor or other provider conducting such examinations to release to and discuss with the company the results of such examinations.

ACCOMMODATIONS. I also understand that if I have a protected disability that affects my ability to do the job I seek, I may ask the Company for a reasonable accommodation. Under Michigan law, such notice must be given no later than 182 days after the date I know or reasonably should know that accommodation is needed.

DRUG ALCOHOL TESTS. I give my consent for the Company, through an authorized testing service of its choice, to collect blood, urine or other sample from me and to conduct any other necessary medical test to determine the presence of alcohol or illegal drugs. I authorize the testing service to release to and discuss with the Company the test results and other relevant medical information. If I am accepted for employment, I also consent to be tested in the above manner during my employment, I also consent to be tested in the above manner during my employment when, in the Company’s judgement, such testing is appropriate. I acknowledge that remaining free of illegal drug use and complying with the Company’s alcohol and substance abuse policy is a condition of employment.

AT-WILL EMPLOYMENT. I understand that if hired my employment with the Company will be on an at-will basis. I understand that this means that my employment is for an indefinite period of time and may be terminated by either the Company or me at any time, with or without cause, and with or without prior notice, warning or discipline. No person other than the President of the Company has the authority to offer employment for any specified period or to make any contact to the foregoing. Moreover, no such agreement by the President will be enforceable unless it is in writing, pertain specifically to me, and is signed by the President.

RELEASE. I release the Company, my current and former employers, the education institutions I have attended, the physicians/counselors/providers who examine me, the drug/alcohol testing service, and each of their staffs and employees from any and all liability associated with the disclosure and discussion of any information, records or other documents that pertain to me.

CRIMINAL HISTORY. In additional, depending on the position for which I am applying, I understand that the Company may request a criminal history pertaining to me. if such a check will be performed by an outside service, I understand that I will be provided with additional notices, authorizations and information about that process and my rights.

WAIVE OF LIMITATIONS PERIODS. In exchange for the Company considering my applications for employment, I agree that I must file any and all claims and/or lawsuits arising out of or pertaining in any way to my application for employment, employment or termination of employment within 270 days of the event giving rise to the claim and/or lawsuit. I understand that the applicable statues of limitation may be longer than 270. However, I agree to be bound by this shorter, 270 day period of limitations and accordingly WAIVE ANY STATUE OF LIMITATIONS TO THE CONTRARY.*

Type Signature *

Today's Date*

Month/Day/Year