Application for Employment

Application for Employment
It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.
Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer the questions on this application. You may attach a résumé, but all questions must be answered.
PERSONAL DATA
Name (last, first, middle)*

First NameMiddle InitialLast Name
Referred By
Street Address and/or Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Home Telephone Number
Cellular Telephone Number
Date you can start work*

MonthDayYear
Date
Salary Desired*
Have you ever applied to this company before?*

YesNo
When?
POSITION INFORMATION

Please check all that you're willing to work.
Position Desired*
Desired Shift*

Day Shift (5:00 AM - 3:30 PM)Night Shift (3:30 PM 2:00 AM)
Are you currently employed?*

YesNo
If so, may we contract your current employer?

YesNo
Do you have a high school diploma or GED?*

YesNo
Are you authorized to work in the U.S. an unrestricted basis?*

YesNo
Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.)*

YesNo
If yes, explain:

QUALIFICATIONS: Education*

	School Name & Address	Subjects Studied	Years Attended	Did You Graduate?
High School
College
Other (Trade School, Technical School, etc.)

QUALIFICATIONS: Military (skip if no service)

	Branch	Rank	Dates Served	Active Duty?
US Military Service

SPECIAL SKILLS List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

References. Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references.*

	Name	Address/City/State	Phone	Years Known
1
2
3

WORK HISTORY

Start with your present or most recent employment and work back.
May we contact your present employer?*

YesNoN/A
Job Title #1
Start Date (mo/day/yr)

MonthDayYear
Date
End Date (mo/day/yr)

MonthDayYear
Date
Company Name
Supervisor's Name
Phone Number
City, State, Zip

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties:
Reason for Leaving
Starting Salary
Ending Salary
Job Title #2
Start Date (mo/day/yr)

MonthDayYear
Date
End Date (mo/day/yr)

MonthDayYear
Date
Company Name
Supervisor's Name
Phone Number
City, State, Zip

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties:
Reason for Leaving
Starting Salary
Ending Salary
Job Title #3
Start Date (mo/day/yr)

MonthDayYear
Date
End Date (mo/day/yr)

MonthDayYear
Date
Company Name
Supervisor's Name
Phone Number
City, State, Zip

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties:
Reason for Leaving
Starting Salary
Ending Salary
Job Title #4
Start Date (mo/day/yr)

MonthDayYear
Date
End Date (mo/day/yr)

MonthDayYear
Date
Company Name
Supervisor's Name
Phone Number
City, State, Zip

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Duties:
Reason for Leaving
Starting Salary
Ending Salary
By signing below, I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of information may result in the rejection of my application or, if employed, immediate dismissal. I authorize the company to investigate all statements contained in this application, including contacting any references or previous employers listed above. I further authorize those individuals and organizations to release any relevant information regarding my past employment or other pertinent matters, personal or otherwise. I release the company and all parties providing such information from any liability that may arise from the disclosure or use of this information. I understand and agree that no representative of the company has the authority to enter into any employment agreement for a specified period of time, or to make any assurances or agreements contrary to the above, unless such agreement is in writing and signed by an authorized company representative. This authorization does not permit the release or use of medical or disability-related information in a manner prohibited by the Americans with Disabilities Act (ADA) or any other applicable federal or state laws.
PLEASE NOTE: AFTER YOU SIGN AND DATE, THERE ARE MORE PAGES TO COMPLETE.
Applicant Signature*

Clear
Date*

MonthDayYear
Date

Coil Manufacturing Inc
940 Alton Parkway
Birmingham, AL 35210
Criminal Background Check Release Form
PERSONAL DATA
Name (last, first, middle)*

First NameLast Name
CURRENT Street Address and/or Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PREVIOUS Street Address and/or Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Aliases or Other Names Used
Drivers License or ID Number*
State Issued*
Sex*
Date of Birth*

MonthDayYear
Date
Race*
In connection with my application for employment (including any contract for services) with Coil Manufacturing Inc (hereinafter referred to as "CMI"), I understand that investigative inquiries may be conducted regarding my background. These inquiries may include, but are not limited to, consumer credit reports, criminal conviction records, motor vehicle reports, and other relevant background information. Such reports may contain details regarding my character, work habits, job performance, experience, and the reasons for separation from previous employment.
I further understand that CMI may request information from various federal, state, and local agencies that maintain records relating to my driving history, credit, criminal and civil matters, education, police arrest records, and other information maintained by criminal justice agencies in the United States.
I hereby authorize, without reservation, any individual, organization, or agency contacted by CMI to release any and all information requested in connection with these inquiries.
PLEASE NOTE: AFTER YOU SIGN AND DATE, THERE ARE MORE PAGES TO COMPLETE.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Page 3 of 4

Coil Manufacturing Inc
940 Alton Parkway
Birmingham, AL 35210
Applicant Consent Form
Coil Manufacturing Inc (hereinafter referred to as "CMI") maintains a drug and alcohol policy that applies to all employees. A copy of this policy is available upon request for your review. Employment is contingent upon successfully completing a physical examination and complying with CMI's drug and alcohol policy. Both the physical examination and the policy include testing for alcohol, narcotics, hallucinogens, marijuana, and other controlled substances.
By signing this form, you acknowledge that you have either reviewed and understood CMI's drug and alcohol policy or declined the opportunity to do so. You consent to any blood, breathalyzer, or urinalysis tests required by the company as part of your physical examination or any other employment-related procedures. You also release the company, its officers, agents, and employees from any liability arising out of or related to such examinations and tests.
If hired, you consent to undergo any drug or alcohol testing required by the company, authorize the release of all related test results to the company, and release the company, its officers, agents, and employees from any liability associated with such testing.
Additionally, if hired, you agree to reimburse the company for all expenses associated with the pre-employment testing described above, should you voluntarily terminate your employment within the first 90 days of service.
You understand that failure to sign this consent form will be considered a voluntary withdrawal of your employment application and will remove you from further consideration.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
CLICK SUBMIT TO SEND US YOUR APPLICATION
Page 4 of 4
Should be Empty:

Application for Employment

PERSONAL DATA

POSITION INFORMATION

WORK HISTORY

Criminal Background Check Release Form

PERSONAL DATA

Applicant Consent Form