Employment Application Form

VOLUNTARY SELF-IDENTIFICATION FORM FOR APPLICANTS WITH NEW EEO-1 RACE AND ETHNICITY CATEGORIES

TO ALL APPLICANTS:

Our company is an Equal Opportunity Employer and as such we are subject to certain governmental recordkeeping and reporting requirements. At this time, we are asking you to help us meet our obligations by completing the following information. This information will only be used in accordance with the provisions of applicable laws, executive orders, and regulations. Providing this information is voluntary and refusal to do so will not subject you to any adverse treatment. All information provided will be kept confidential. It will remain separate from your employment application and will not be used in any way during the interviewing or hiring process or to make a selection decision.

Required Fields *

No thank you - I want to apply for a position without completing this voluntary form

Part 1 - General Information

First Name
Last Name
Middle Initial
Position Applied For

Part 2 - Gender, Ethnicity and Race Information

Gender
Ethnicity

Part 3 - Referral Source

Please indicate how you heard about this opening
If Other, please specify
Employment Application Form

It is the policy of IDC Automatic Company to provide equal employment opportunities without regard to race, creed, color, religion, national origin, sex, marital status, status with regard to public assistance, disability, age, membership on a local human rights commission or sexual orientation.

Contact Information

Position Applied For *
First Name *
Last Name *
Middle Initial *
Street Address *
City *
State / Province *
Zip Code *
Social Security Number
Phone Number *
Email *
Previous Address

If you have lived at the above address less than twelve months, complete the following four fields:

Previous Address
Previous City
Previous State / Province
Previous Zip Code
Work History
Have you worked for this organization before?
If so, when?
Are you legally eligible for employment in the United States?
(Proof of citizenship or immigration status will be required upon employment.)
Are you available to work:
Can you work overtime whenever scheduled or requested?
Can you work weekends whenever scheduled or requested?
Do you have reliable transportation to work?
On what date would you be available for work?
List states and counties of residence for the past seven years:
Education

High School

Name
City
State / Province
Did you graduate?

Trade School

Name
City
State / Province
Did you graduate?

College

Name
City
State / Province
Did you graduate?

Other School

Name
Employment Experience

Your application will not be considered unless every question in this section is answered. Since we make every effort to contact previous employers, the correct telephone numbers of past employers are critical. List all previous employers for whom you have worked during the last ten years. Explain any lapses between times when employed.

Most Recent Employer

Are your currently working for this employer?
If Yes, may we contact?
Company Name
Street Address
City
State / Province
Zip Code
Phone Number
Beginning Date Employed
Ending Date Employed
Job Title
Supervisor Name
Duties
Starting Weekly Pay
Ending Weekly Pay
Reason for Leaving

Second Most Recent Employer

Are your currently working for this employer?
If Yes, may we contact?
Company Name
Street Address
City
State / Province
Zip Code
Phone Number
Beginning Date Employed
Ending Date Employed
Job Title
Supervisor Name
Duties
Starting Weekly Pay
Ending Weekly Pay
Reason for Leaving

Third Most Recent Employer

Are your currently working for this employer?
If Yes, may we contact?
Company Name
Street Address
City
State / Province
Zip Code
Phone Number
Beginning Date Employed
Ending Date Employed
Job Title
Supervisor Name
Duties
Starting Weekly Pay
Ending Weekly Pay
Reason for Leaving

Fourth Most Recent Employer

Are your currently working for this employer?
If Yes, may we contact?
Company Name
Street Address
City
State / Province
Zip Code
Phone Number
Beginning Date Employed
Ending Date Employed
Job Title
Supervisor Name
Duties
Starting Weekly Pay
Ending Weekly Pay
Reason for Leaving

Lapses in Employment

Comments regarding lapses in employment, if applicable
Job Related Skills

Note: do not fill out any part of this section that you believe will be non-job related. Please exclude any indicative of race, creed, color, religion, national origin, sex, marital status, status with regard to public assistance, disability, age, membership on a local human rights commission or sexual orientation.

If the job requires, do you have the appropriate valid driver's license?
DL #
Type
State of Issue
Do you have any moving violations?
If yes, please describe (include the date, city, county and state where it occurred)
Please list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or company

If applying for an office position ...

Do you type?
Approximate WPM
Business machines you can operate
Have you been given a job description or had the requirements of the job explained to you?
Do you understand these requirements?
Can you perform the requirements of this job with or without reasonable accommodation?

References

Include only individuals familiar with your work ability. Do not include relatives.

Reference 1

Name
Years Known/Relationship
Address
Phone

Reference 2

Name
Years Known/Relationship
Address
Phone

Reference 3

Name
Years Known/Relationship
Address
Phone

Additional Information

I hereby state that the information given by me in this application is true in all respects. I understand that if I am employed and the information is found to be false in any respect, I will be subject to dismissal without notice at any time.

In making this application for employment, it is understood that an investigative consumer report may be prepared whereby information concerning my character, general reputation, personal characteristics and mode of living may be obtained through personal interviews. I hereby authorize my former employers to release information pertaining to my work record, my work habits, and my work performance while in their employ. I hereby authorize the individuals listed as personal references to release any personal information that may pertain to my work habits or work performance. Also an investigation may be requested to be made of my credit standing by a consumer reporting agency to verify any of this information, including, but not limited to, criminal history and motor vehicle driving records. I authorize both or either of such investigations to be made. I further understand that upon written request made within a reasonable period of time, I have the right to obtain additional detailed information about the nature and scope of these investigations, if made.

I authorize Industrial Door Company, Inc. to investigate all statements contained in this application and hereby release any said person, former employers, schools, companies, law enforcement authorities, and Industrial Door Company, Inc. It is understood and agreed that any misrepresentation by me in this application or during the interview will be sufficient cause for cancellation of the application and/or for separation from the Company's service if I have been employed.

I understand and agree that any employee handbook which I may receive will not constitute an employment contract, but will be merely a gratuitous statement of Industrial Door Company, Inc.'s current policies. In the event of my employment by Industrial Door Company, Inc., I agree to abide by all present and subsequently issued policies and rules of Industrial Door Company, Inc.

I understand that the Company will require applicants for employment to take a urinalysis or blood test for drug screening as part of a pre-employment physical examination, and that any offer of employment with Industrial Door Company, Inc. is conditioned upon the results of my physical examination (including urinalysis or blood tests for drug screens) being satisfactory. I understand that if I am employed with Industrial Door Company, Inc., the Company will require that I submit to a drug or alcohol screen if I am involved in an on-the-job accident or if the Company has a reasonable suspicion that I am under the influence of drugs or alcohol, and I hereby authorize the release of the results of any physical examinations or drug tests required herein to Industrial Door Company, Inc. I further understand that the company may inspect all lockers and any bags (including purses or briefcases) or parcels brought into or taken out of Industrial Door Company, Inc., and that my refusals to submit to a urinalysis, blood test or search, when requested to do so, may result in the termination of my employment.

I UNDERSTAND AND AGREE THAT IF I AM OFFERED EMPLOYMENT BY INDUSTRIAL DOOR COMPANY, INC., MY EMPLOYMENT WILL BE FOR NO DEFINITE TERM AND THAT EITHER I, OR INDUSTRIAL DOOR COMPANY, INC., WILL HAVE THE RIGHT TO TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE. I ALSO UNDERSTAND THAT THIS STATUS CAN ONLY BE ALTERED BY A WRITTEN CONTRACT OF EMPLOYMENT WHICH IS SPECIFIC AS TO ALL MATERIAL TERMS AND IS SIGNED BY ME AND THE PRESIDENT OF THE COMPANY.
*
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