DELUXE PLASTICS MEDFORD Job Application Form

DELUXE PLASTICS - MEDFORD EMPLOYMENT APPLICATION

Employment at 939 South Whelen Ave., Medford, WI 54451
APPLICANT INFORMATION
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Best Time to Call
E-mail*
Have you ever been employed by WADAL Plastics or Deluxe Plastics before?

YesNo
If yes, when:
Have you ever applied at WADAL Plastics or Deluxe Plastics before?

YesNo
If yes, when:
Are you 18 years of age or older?*

YesNo
If ever employed or attended school under a different name, please indicate: (type 'N/A' if this does not apply to you)*
Are You a U.S. Citizen or do you otherwise have legal authorization to work in the U.S., which is not limited to a particular employer (Proof of authorization to work will be required upon employment)*

YesNo

EMPLOYMENT HISTORY
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Start Date

MonthDayYear
End Date

MonthDayYear
Salary
Supervisor Name
Reason for Leaving?
May We Contact?

YesNo
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
List your job duties
Previous Employment:
Employer Name
Position
Start Date

MonthDayYear
End Date

MonthDayYear
Salary
Supervisor Name
Reason for Leaving?
May We Contact?

YesNo
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
List your job duties
Employer Name
Position
Start Date

MonthDayYear
End Date

MonthDayYear
Salary
Supervisor Name
Reason for Leaving?
May We Contact?

YesNo
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
List your job duties
If presently employed, why do you wish to change positions?
Please account for all periods of time where you were unemployed for one month or more since you left school, until the present time.
From

MonthDayYear
To

MonthDayYear
State what you were doing:
From

MonthDayYear
To

MonthDayYear
State what you were doing:
From

MonthDayYear
To

MonthDayYear
State what you were doing:

EDUCATION HISTORY
High School
Name of High School Attended
Number of Years Attended
Graduated?

YesNo
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
College
Name of College/University Attended
Number of Years Attended
Graduated?

YesNo
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Area of Study/Degree
Year Graduated
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graduated?

YesNo
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Area of Study/Degree
Year Graduated
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

YesNo
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Area of Study/Degree
Year Graduated

REFERENCES
Please list at least one previous supervisor.
Reference 1*
Name of Reference
Relationship*
Years Acquainted*
Phone*
Email
Reference 2*
Name of Reference
Relationship*
Years Acquainted*
Phone*
Email
Reference 3*
Name of Reference
Relationship*
Years Acquainted*
Phone*
Email

COVER LETTER & RESUME (optional)
Cover Letter

Upload a File

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Resume

Upload a File

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PLEASE READ BEFORE SIGNING
I understand and acknowledge that my employment is at-will, which means that either I or Deluxe Plastics may terminate employment at any time and for any reason with or without notice. I also understand that no one has any authority to enter into any agreement contrary to the preceding sentence except for a written agreement signed by a member of management.

I hereby affirm that the information contained in this application (and resume, if any) is accurate and complete, and I understand that any false or misleading information or omissions will disqualify me from employment consideration or result in termination of employment, regardless of when discovered.

I hereby authorize Deluxe Plastics to (1) investigate all statements contained in this application and/or resume; (2) contact my former employers and other listed references or any other persons who can provide information relative to my employment consideration; (3) contact any persons or entities regarding my employment application; (4) and make any other inquiries that the employer deems relevant in arriving at a decision regarding my application for employment. I consent to any contacted person, including former employers, to provide information about me and I covenant not to sue any such person for information provided about me.
Signature*

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Todays Date*

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