Smith Brothers | Employment Application

Application for Employment

Equal Access to programs, services and employment opportunities is available to all persons without regard to race, color, religion, sex (including pregnancy), national origin, ancestry, age, disability, veteran status, genetic information, or any other basis protected by federal, state, and/or local law.

In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations for the application and/or interview process should notify the HR Department. Examples of reasonable accommodations include making a change to the application process; providing written materials in an alternate format such as braille, large print, or audio recording; using a sign language interpreter; using specialized equipment; or modifying testing conditions.

                    First Name:
                    
                    M.I.:
                    
                    Last Name:
                    
                    Phone:
                    
                    Valid Email Address:

                    Permanent Address:
                    
                Apt/Suite:
                    
                    City:
                    
                    State:
                    
                    Zip:

Position(s) Applied For:

Plant Location Applying Form:

Referral Source (e.g., Walk-in, Job Posting, Company's Website, Associate Referral, etc.):

Please answer Type of Employment and all Yes/No questions. If N/A is available, select that if that answer pertains to you. Please do not leave any Yes/No question(s) unanswered.

Employment History

Please provide the following information for your most recent employer(s) if applicable.

Job

Compensation Final

Job

Compensation Final

Employment History (continued)

Have you ever been fired or asked to resign from a job?

Yes

If Yes, please explain.

Educational Background

Starting with your most recent school attended, provide the following information.

School (include City & State)	Years Completed	Degree	GPA	Major/Minor

References

List names and phone numbers of three (3) business/work references who are not related to you and are not previous supervisors. If not applicable, list three (3) school or personal references who are not related to you. NOTE: At least 1 reference is required.

Reference Name	Reference Profession	Reference Relationship	Reference Phone	# Years Known

Related Information

To what job-related organization (professional, trade, etc.) do you belong?

Is there any other job-related information you want us to know about you?

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.

I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives, for seeking, gathering, and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.

I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to re-apply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her race, color, religion, sex (including pregnancy), national origin, ancestry, age, disability, veteran status, genetic information, or any other protected status under applicable federal, state, or local law.

NOTE: This Company complies with Indiana law prohibiting smoking in enclosed areas within places of employment.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant

Date

 
AN EQUAL OPPORTUNITY EMPLOYER