DELUXE PLASTICS MEDFORD Job Application Form

DELUXE PLASTICS - MEDFORD EMPLOYMENT APPLICATION

Employment at 949 South Gibson Street, Medford, WI 54451
APPLICANT INFORMATION
Full Name *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone

Area Code Phone Number
Cell Phone

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

Yes No
If yes, when:
Have you ever applied at WADAL Plastics or Deluxe Plastics before?

Yes No
If yes, when:
Are you 18 years of age or older? *

Yes No
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) *

Yes No

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

Month Day Year
End Date

Month Day Year
Salary
Supervisor Name
Reason for Leaving?
May We Contact?

Yes No
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

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

Month Day Year
End Date

Month Day Year
Salary
Supervisor Name
Reason for Leaving?
May We Contact?

Yes No
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

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

Month Day Year
End Date

Month Day Year
Salary
Supervisor Name
Reason for Leaving?
May We Contact?

Yes No
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
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

Month Day Year
To

Month Day Year
State what you were doing:
From

Month Day Year
To

Month Day Year
State what you were doing:
From

Month Day Year
To

Month Day Year
State what you were doing:

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

Yes No
Location

Street Address

Street Address Line 2

City State / Province
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes No
Location

Street Address

Street Address Line 2

City State / Province
Area of Study/Degree
Year Graduated
Graduate School
Name of Graduate School Attended
Number of Years Attended
Graduated?

Yes No
Location

Street Address

Street Address Line 2

City State / Province
Area of Study/Degree
Year Graduated
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes No
Location

Street Address

Street Address Line 2

City State / Province
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
Resume

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 *

Month Day Year
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