Dreamline Mfg., Inc.P.O. Box 1250 · Cabot, AR 72023
Employment Application
APPLICANT INSTRUCTIONS
If you need help to fill out this application form or for any phase of the employment process, please notify the person that gave you this form and every effort will be made to accommodate your needs in a reasonable amount of time.
1. Please read "APPLICANT NOTE."
2. Complete both sides of this form.
3. If more space is needed to complete any question, use the comments section on the back.
4. Print clearly; incomplete or illegible applications will not be processed.
5. Do not fill out any other attached forms until instructed.
TODAY'S DATE:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NAME:
First Name
Middle Initial
Last Name
SOCIAL SECURITY NUMBER:
HOME PHONE:
Format: (000) 000-0000.
WORK PHONE:
Format: (000) 000-0000.
CURRENT ADDRESS:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PRIOR ADDRESS:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
APPLICANT NOTE
This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin, or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment and prior to reporting to work, you are required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.
AVAILABILITY
For which position are you applying?
What date can you start?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you previously worked at Dreamline?
YES
NO
When?
EDUCATION
Please circle the highest grade completed.
5 6 7 8 9 10 11 12 13 14 15 16+
Rows
Name
City / State Graduate?
High School
College
Other
SECURITY
List states and counties of residence for the past seven years.
Have you used any names or Social Security numbers other than those on this page? If so, please list on the back.
Yes
No
Have you been convicted of a felony and/or served time in the past seven years? If so, please describe below. (In accordance with company policy, this information will be reviewed for job-relatedness and time since the last conviction.)
Yes
No
Rows
CITY / STATE
CHARGE
1.
2.
JOB-RELATED SKILLS
NOTE: Do not fill out any part of this section you believe to be non-job-related.
Have you had any moving traffic violations? Please describe.
Yes
No
Please list any other skills, licenses, or certificates that may be job-related that you feel would be of value to this job or company.
Back
Next
Dreamline Mfg., Inc.
Employment Application · continued
Have you been given a job description or had the requirements of the job explained to you?
Yes
No
Do you understand these requirements?
Yes
No
Can you perform the requirements of this job with or without reasonable accommodation?
Yes
No
EMPLOYMENT REFERENCES
Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical.
Most Recent Employer
Are you currently working for this employer?
Yes
No
If yes, may we contact?
Yes
No
Company Name
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Format: (000) 000-0000.
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Job Title
Supervisor
First Name
Last Name
Duties
Salary
per (Hour, Week, Month)
Reason for Leaving
Second Most Recent Employer
Company Name
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Format: (000) 000-0000.
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Job Title
Supervisor
First Name
Last Name
Duties
Salary
per (Hour, Week, Month)
Reason for Leaving
Third Most Recent Employer
Company Name
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Format: (000) 000-0000.
From
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
To
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Job Title
Supervisor
First Name
Last Name
Duties
Salary
per (Hour, Week, Month)
Reason for Leaving
REFERENCES
Include only individuals familiar with your work ability. Do not include relatives.
REFERENCES Include only individuals familiar with your work ability. Do not include relatives.
Rows
Address / Phone
Years
Known / Relationship
1.
2.
COMMENTS
Comments
Ask for an additional page, if necessary.
CERTIFICATION AND RELEASE
I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information including, but not limited to, criminal history and motor vehicle records. I authorize all persons, schools, companies, and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
I understand that, if hired, my employment will be at-will and I can resign or be terminated at any time for any reason.
I further understand that this application will only be effective for thirty days and, after that time, I will not be considered for employment unless I have submitted another application.
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
Should be Empty: