Application for Employment

APPLICATION FOR EMPLOYMENT

KEYSTONE FOAM CORPORATION IS AN EQUAL OPPORTUNITY EMPLOYER AND DOES NOT DISCRIMINATE BECAUSE OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, SEX, AGE, OR HANDICAP.
Applicants Name*
When are you available to start work?

MonthDayYear
Date
What shift(s) can you work? (Please check all that apply)
6:00 AM - 4:30 PM Monday - Thursday3:30 PM - 2:00 AM Monday- Thursday9:00 PM- 7:30 AM Sunday PM -Thursday AM
8:00 AM - 1:00 PM1:00 PM - 6:00 PM4:00 PM - 9:00 PM9:00 PM - 2:00 AM12:00 AM - 5:00 AMOther
Position(s) Applied For
Date of Application

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-Mail Address
YesNo
NoYes
YesNo
Full-TimePart-TimeTemporary
YesNo
YesNo
YesNo
What is your minimum hourly salary requirement?
YesNo
NoYes
If yes, then whom?
NoYes
If yes, please explain
Employment History

List your last three employers, starting with the most recent, including military experience. Explain any gaps in employment in comments section below.
Employer (1)
Type of Business
Address
Phone
Format: (000) 000-0000.
Dates Employed
Salary
Job Title
Duties
YesNo
Immediate Supervisor's Name
May we contact for reference?
Explain reason for desiring change
Employer (2)
Type of Business
Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Dates Employed
Salary
Job Title
Duties
YesNo
Immediate Supervisor's Name
YesNo
Explain reason for desiring change
Employer (3)
Type of Business
Address
Phone Number
Format: (000) 000-0000.
Dates Employed
Salary
Job Title
Duties
YesNo
Immediate Supervisor's Name
May we contact for reference? blanks
Explain reason for desiring change
COMMENTS

Education

Rows	Name & Address	Course of Study	# of Years Completed	Degree/ Diploma
High School
College
Other

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with our company. List any additional information you would like us to consider.
It is understood an areed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/ or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representitive of the employer has the authority to make any assurances to the contrary.

I give the employer the right to investigate all refrences and to source additional information about me, if job related. I hereby release from liability the employer and it's representitives for seeking such information and all other persons, corporations, or organizations for furnishing such information.

The employer is an equal opportunity employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, and federal law.

I understand that my application will be actively considered for a period of 30 days.

In consideration of my employment I agree to conform to all rules and regulations of Keystone Foam Corporation, and non-compliance therewith may subject me to dismissal at the option of Keystone Foam Corporation.
Yes
Signature of Applicant*

Clear
Date*

MonthDayYear
Date
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Employment History