Job Application – Rising Star Hydraulics

Job Application

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

PERSONAL INFORMATION

First Name

Middle Name

Last Name

Address

Street

City

State

Zip Code

Phone Number

Are You 18 or Older?

EMPLOYMENT DESIRED

Position Applying For

Date You Can Start

Salary Desired

Are You Employed Now?

If So May We Inquire of Your Present Employer

Ever Applied to This Company Before?

Where?

When?

Have You Ever Been Convicted of a Felony?

If Yes, Please List Details (This Does Not Automatically Exclude You from Employment)

Would You Agree to a Pre-Employment Drug Screening & Background Check?

Would You Allow Us to Pull Your MVR Report if Your Job Entails Driving?

EDUCATION

High School Name

High School Location

Years Attended

Did You Graduate?

Subject Studied

College Name

College Location

Years Attended

Did You Graduate?

Subject Studied

The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less and 70 years of age.

GENERAL

Subjects of Special Study or Research Work

U.S. Military Service

Rank

Present Membership in National Guard or Reserves

How Did You Hear About this Job?

FORMER EMPLOYERS

List Below Last Four Employers, Starting with Last One First

Dates Employed

Name & Address of Employer

Salary

Position

Reason For Leaving

Dates Employed

Name & Address of Employer

Salary

Position

Reason For Leaving

Dates Employed

Name & Address of Employer

Salary

Position

Reason For Leaving

Dates Employed

Name & Address of Employer

Salary

Position

Reason For Leaving

REFERENCES

Give the Names of Three Persons Not Related to You, Whom You Have Known at Least One Year.

Reference 1 Name

Address

Business

Years Acquainted

Reference 2 Name

Address

Business

Years Acquainted

Reference 3 Name

Address

Business

Years Acquainted

PHYSICAL RECORD

Do You Have Any Physical Limitations That Preclude You From Performing Any Work For Which You Are Being Considered?

If Yes, Please Describe

Emergency Contact Name

Address

Phone Number

"I Certify That The Facts Contained In This Application Are True And Complete To The Best Of My Knowledge And Understand That, If Employed, Falsified Statements On This Application Shall Be Grounds For Dismissal.

I Authorize Investigation Of All Statements Contained Herein And The References Listed Above To Give You Any And All Information Concerning My Previous Employment And Any Pertinent Information They May Have Personal Or Otherwise, And Release All Parties From All Liability For Any Damage That May Result From Furnishing Same To You.

I Understand And Agree That , If Hired, My Employment Is For No Definite Period And May, Regardless Of The Date, Of Payment Of My Wages And Salary, Be Terminated At Any Time Without Any Prior Notice."

Today's Date

Name Of Applicant

This Form has been designed to strictly comply with State and Federal Fair, employment practice laws prohibiting employment discrimination.