Job Application

Application For Employment

Vuteq USA
Vuteq considers all applicants for employment without regard to race, color, religion, gender, national origin, age, disability, marital or militarystatus, or based on any individual's status in any group or class protected by applicable federal, state or local law. Vuteq also provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require an accommodation in the application process, please let us know. Thank you!
Today's Date *

Month Day Year
Date
Referred by
** Referrer & Applicant must be employed at the same location.
PERSONAL DATA
First *
Last *
Middle *
Maiden
Address *

Address

Street Address Line 2

City State

Zip Code
PHONE *
ALTERNATE PHONE
EMAIL
example@example.com
EMPLOYMENT DESIRED
In many Vuteq positions, a flexible workschedule is important in meeting the needs of our business, and inability to satisfy these work schedules may limit further consideration of your application. Please indicate if you are able and willing to perform the following schedules:
Position you are applying for *
Date available for work *

Month Day Year
Date
Work availability (Check all that apply) *

Blue Shift 6:30am-3:15pm Gold Shift 7:15pm-4:00am Part Time Mon-Fri.
Preferred Shift *
Overtime availability (Check all that apply) *

Daily (Mon - Fri) Saturday Sunday
GENERAL INFORMATION
Do you have unlimited authorization to work in the United States? If no, please indicate your immigration status or authorization to work (specify) *

Yes NO
If no, please indicate your immigration status or authorization to work (specify)
Have you previously applied to Vuteq? *

YES NO
If yes, provide dates

Month Day Year
Date
Agency Name
If yes, provide dates

Month Day Year
Date
Have you previously worked for Toyota or any Toyota supplier? *

YES NO
If yes, provide company name(s)
How were you introduced to us? *

Employee referral Billboards Radio Internet Job Fair Other
WORK HISTORY
Please give accurate and complete information. Start with present or most recent employer. Include self-employment, part-time work, military employment and any work performed on a volunteer basis. Account for your entire employment history, minimum of 5 years, including significant gaps in employment. All information must be included, even if you are attaching a resume.
Previous Employer #1 *
Start date *
End date
Address *

Address

Street Address Line 2

City State
Job Title *
Work performed *
Starting wage *
Final wage *
Reason for leaving *
Previous Employer #2
Start date *
End date *
Address

Address

Street Address Line 2

City State
Job Title *
Work performed *
Starting wage
Final wage
Reason for leaving
EDUCATION
High School *
City, State *
e.g., Indianapolis, IN
Highest Grade Completed *

9 10 11 12
Diploma or GED Received? *

Yes No
OTHER EDUCATION
Additional expeirence or other training
City, State
Certificate received
SKILLS AND QUALIFICATIONS
Can you fluently speak, read and write in English? *

Yes No
Are there any other languages you speak fluently? *

Yes No If so, please list:
List any machines/equipment you can operate (including fork truck)
List any special skills or relevant licenses
Job Duty Waiver

Essential Funtions
Can you perform above mentioned essential job functions with or without a reasonable accommodation?
Signature *

Clear
Date *

Month Day Year
Date
CRIMINAL BACKGROUND
Do not answer regarding convictions which have been expunged, sealed, annulled, dismissed, erased, impounded, cleared, vacated or officially pardoned. A conviction will not necessarily preclude employment, as each case will be reviewed on its individual facts. Failure to honestly answer this question will result in discontinued consideration of your application or termination of your employment.
Have you ever been convicted of a criminal offense, either felony or misdemeanor? *

YES NO
Number of Charges
If yes, provide details of all prior convictions:
Charge 1
Disposition (Misdemeanor/Felony)
DATE

Month Day Year
Date
LOCATION (City)
Charge 2
Disposition (Misdemeanor/Felony)
DATE

Month Day Year
Date
LOCATION (City)
Charge 3
Disposition (Misdemeanor/Felony)
LOCATION (City)
DATE

Month Day Year
Date
Fitness-for-Work Drug/Alcohol Testing Policy and Informed Consent and Release of Liability Document

Vuteq USA, Inc. has a responsibility to provide a safe, healthful, and productive work environment and to promote high standards of health and safety for its Team Members. Consistent with this commitment, Vuteq USA, Inc. strives to maintain a work environment free from the effects of illegal drugs, alcohol and substance abuse.

Therefore, Vuteq USA, Inc. will not knowingly employ any job applicant who uses illegal drugs or is a substance abuser. Vuteq USA, Inc. policy is to administer a pre-employment drug screening test to all prospective Team Members. Any applicant who refuses to consent to a test or tests positive for illegal use of a controlled substance and/or alcohol will not be hired.

Vuteq USA, Inc. Informed Consent and Release of Liability

I UNDERSTAND that according to company policy, which I have read and understand, I am required to submit a sample of my urine for chemical analysis. I understand that this analysis will be conducted by a third party. The results will be reviewed by a certified physician and this physician may contact the applicant directly for an interview.

THE PURPOSE of this analysis is to determine the absence or presence of drugs and/or alcohol. The results will be reported to Vuteq USA, Inc.

I CONSENT freely and voluntarily to Vuteq USA, Inc request for a urine specimen. I hereby release and hold harmless Vuteq USA, Inc., its employees, agents, directors, and owners from any and all claims or liability whatsoever arising from this request to furnish my specimen, testing of my specimen, and any decision concerning employment made by Vuteq USA, Inc. in whole or in part, based upon the results of the drug screen.

First Name Last Name Signature* Date*
Certification, Authorization, Waiver and Agreement

Please read and initial each paragraph below:

I agree and hereby authorize Vuteq USA, Inc. to conduct a background inquiry to verify the information on this application and other matters related to my suitability for employment and further, authorize my current and former employers to disclose to the company any and all letters, reports, and other information pertaining to my employment with them, without giving me prior notice of such disclosure.

I understand that nothing contained in the application or conveyed to me during any interview which may be granted is intended to create an employment contract, implied or explicit, between Vuteq USA, Inc. and me. In addition, I understand and agree that if employed, my employment relationship with Vuteq USA, Inc. is strictly voluntary and at our mutual will. I understand that if employed, my employment is for no definite period and may be terminated at any time, with or without prior notice, with or without cause or reason, at the option of either myself or Vuteq USA, Inc., and that no promises or representations contrary to the forgoing binding on Vuteq USA, Inc unless made in writing and signed jointly by the President/CEO and myself.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on the application, or any false, incomplete, or misleading information in my application or interview, or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

My signature below certifies that I have read and understand the Certification, Authorization, Waiver, and Agreement, and agree to the terms and conditions outlined in this document.

Applicant’s Signature: Signature* Date: Date*
Should be Empty:

Application For Employment

PERSONAL DATA

EMPLOYMENT DESIRED

GENERAL INFORMATION

WORK HISTORY

EDUCATION

OTHER EDUCATION

SKILLS AND QUALIFICATIONS

Job Duty Waiver

CRIMINAL BACKGROUND