Application for Employment

We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally reconized basis, including but not limited to race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, non-job related handicap, disability, or veteran status.

PERSONAL BACKGROUND
Last Name:
First Name: Middle Name: SS#--
Present Address:
City: State Zip Code:
Permanent Address:
City: State Zip Code:
Phone Number:
-- Referred by:
Position Applying For:
 Date Available: Salary Desired
Able to work days or nights?
 YesNo ... If no, please explain
Are You Employed?
 Yes No ... If so, may we inquire of your present employer? yes no
Ever applied to this company bebore?
 YesNo Where? When?
Are you willing to work overtime?
 Yes
No
Are you willing to submit a drug and alcohol test upon hire?
 Yes
No
U.S. Military or Naval Service
 Rank
If driving is a requirement of the job which you are applying, do you have a current valid driver's license? Yes No
If less than 18 years of age, do you have a work permit? Yes No
After employment, can you sumbit verification of your legal right to work in the U.S.? Yes No
Have you ever been convicted of a felony? (a conviction record will not necessarily be a bar to employment) Yes No
If yes, please explain:
EDUCATIONAL
 BACKGROUND
NAME & LOCATION OF SCHOOL
SELECT HIGHEST GRADE
COMPLETED
GRADUATED?
MAJOR AREAS OF STUDY
HIGH SCHOOL
9 10 11 12
YES NO GED
COLLEGE
13 14 15 16
YES NO
TRADE OR
BUSINESS SCHOOL
YES NO
WORK EXPERIENCE
(List below last four employers, starting with your present or last place of employment)
Date
Month/Year
Name & Address of Employer
Salary
Position
Supervisor
 Reason for Leaving
Fr:
To:
Fr:
To:
Fr:
To:
Fr:
To:
May we contact your present employer at this time? YES NO
REFERENCES
Give the names of three persons not related to you, whom you have known for at least three years.
Name & Occupation
Address
Phone Number
Years
APPLICANT'S STATEMENT
In signing this application, I certify that all of the foregoing information is a complete & accurate statement of the facts & understand that if any misrepresentation, omission, or fasification were discovered, it will constitute grounds for dismissal. I hereby authorize you to conduct any investigation necessary concerning any part of my background related to the position I am seeking. I release all parties from any liability in connection with the provision and use of such information.


I Understand and agree that, if emplyed by Currier Plastics,I will abide by its rules and regulations, which I understand, are subject to change. I further understand that if hired, my employment is for no definate period of time and may be terminated by either party at any time.

Applicant's Signature:

Date:

Tuesday, September 13, 2005