Today’s Date________________________
Application for Employment
________________________________________________________________________
Top Brass, Inc. is an equal opportunity employer. We comply
with all applicable laws prohibiting discrimination in employment. Please
answer all questions completely. Type or print legibly.
1. Name
____________________________________________________________________________________
Last First Middle
_________________________________________________________________________________________________________
Number and Street City State Zip
2. Phone Number________________ Other
numbers where you can be reached: ___________________________
3. Are you over 18
years of age? Yes____ No____
4. When are you
available to begin employment?
___________________________________________________
5. Type of work
desired:
_______________________________________________________________________
6. Please list the
shifts you are willing to work in order of preference.
(Starting times
may vary.) _____1st _____2nd _____3rd
(
7. Are you willing to
work swing shifts? Yes______ No______
8. Are you willing to
work overtime? Yes______ No______
9. Are you able to
stand most of 8 to 10 hours with or without reasonable accommodation? Yes______ No______
10. Are you able to repeat motion for 2 hours with or without
reasonable accommodation?
Yes______ No______
11. Are you able to lift a box weighing 35 pounds with or
without reasonable accommodation? Yes______ No______
12. Are you able to repetitively press on a table with or
without reasonable accommodation?
Yes______ No______
══════════════════════════════════════════════════════════════════════
13. Employment History - (Please list your
most recent employer first)
A.
Employer: ______________________________
Phone Number:
__________________________________
Address: _________________________________________________________________________________
Number and Street City State Zip
Dates of employment: ____________________________ to _________________________________________ Job title and duties: __________________________________________________________________________
___________________________________________________________________________________________
Starting
pay rate: _________ Ending pay rate:
_________ Reason for leaving: __________________________ Immediate Supervisor: _________________________ May we
contact this employer: Yes_____ No______
If no,
list reason:
____________________________________________________________________________
B. Employer: ______________________________ Phone Number: __________________________________
Address:
_________________________________________________________________________________
Number and Street City State Zip
Dates of employment: ____________________________ to ________________________________________
Job
title and duties:
__________________________________________________________________________
___________________________________________________________________________________________
Starting
pay rate: _________ Ending pay rate:
_________ Reason for leaving: _________________________ Immediate Supervisor: _________________________ May we
contact this employer: Yes_____ No______
If no,
list reason:
____________________________________________________________________________
C. Employer:
______________________________ Phone
Number:
__________________________________
Address:
_________________________________________________________________________________
Number and Street City State Zip
Dates of employment: ____________________________ to ________________________________________
Job
title and duties:
__________________________________________________________________________
___________________________________________________________________________________________
Starting
pay rate: _________ Ending pay rate:
_________ Reason for leaving: _________________________ Immediate Supervisor: _________________________ May we contact this employer: Yes_____
No______
If no,
list reason:
____________________________________________________________________________
14. Have you ever been convicted of a felony? Yes______ No ______ If yes, please explain
__________________________________________________________________________________________________
(A felony
conviction does not constitute an automatic bar to employment unless
substantially related to the position)
══════════════════════════════════════════════════════════════════════
15. Education – Circle the highest
grade completed: 1 2 3 4 5 6 7 8 High School 1 2 3 4
College 1 2 3 4
16. Last school attended?
_____________________________________________________________________________
Name Complete
Address
17. Describe any educational or training programs (including
any academic, military, and vocational, factory or on-the-job programs) you may
have completed that you believe qualifies you for the job you seek.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
18. Describe the kinds of equipment, machines or tools you
have maintained or operated in prior jobs, or have been trained
to maintain or operate:
Equipment Employer/School Dates
______________________________ __________________________________ ___________________________
______________________________ __________________________________ ____________________________
______________________________ __________________________________ ____________________________
______________________________ __________________________________ ____________________________
══════════════════════════════════════════════════════════════════════
19. References - List at least two
references (other than immediate family) who can speak from first hand
experience about your work
capabilities and qualifications.
A. ________________________________________________________________________________________________
Name Number
and Street City State Zip Phone
How is this person acquainted with your capabilities and
qualifications?
_____Supervisor
_____Past co-worker _____Relative _____Teacher _____Other (please explain
__________________________________________________________________________________________________
B.
________________________________________________________________________________________________
Name Number
and Street City State Zip Phone
How is this person acquainted with your capabilities and
qualifications?
_____Supervisor
_____Past co-worker
_____Relative
_____Teacher _____Other
(please explain __________________________________________________________________________________________________
C.
________________________________________________________________________________________________
Name Number
and Street City State Zip Phone
How is this person acquainted with your capabilities and
qualifications?
_____Supervisor
_____Past co-worker
_____Relative
_____Teacher _____Other
(please explain) __________________________________________________________________________________________________
══════════════════════════════════════════════════════════════════════
Recruitment
Information –
20. How did you learn about our company and position? _____Job Advertisement _____Work of mouth
_____Employee Referral (____________________) _____Other____________________________________________
(Name of Employee) (Please explain)
21. Have you previously worked for our company? _____Yes
_____No
(Specify dates and positions)
__________________________________________________________________________
══════════════════════════════════════════════════════════════════════
Applicant – READ THESE
PARAGRAPHS BEFORE SIGNING Top Brass, Inc.
I understand Top Brass, Inc. is an Equal Opportunity employer. Accordingly, Top Brass, Inc. does not discriminate against any applicant or employee because of race, color, religion, sex, sexual preference, pregnancy, national origin, age, marital status, ancestry, disability, or other basis prohibited by federal or Wisconsin law.
I understand Top Brass, Inc. hires on an employment-at-will basis. This means an employee may terminate his or her employment at any time with or without notice. Similarly, Top Brass, Inc. may terminate an employee’s employment at any time for any reason. This policy may not be changed except in writing signed by the president of Top Brass, Inc.
I understand this Application is not a contract or guarantee of employment.
I understand this Application may be considered for a period of one year. After that time, a new application must be submitted for continued consideration.
I understand Top Brass, Inc. may thoroughly investigate my work and personal history and verify all information given in the Application, any related papers, and interviews. I authorize individuals, schools, and employers named in any information I have given, except my current employer, unless otherwise permitted, to provide any information requested about me. I release them from all liability for damages in providing such information.
I represent that all information given in this Application, any related papers, and any interview is complete and accurate. I understand that if any such information is found to be false or if material information in intentionally omitted, adverse employment action, including termination, may occur.
I understand a drug test will be required as a condition to my employment. If an offer is received, I will execute a written consent for such drug test.
_________________________________________________________
Name of Applicant (Print)
_________________________________________________________
Signature of Applicant
_________________________________________________________
Date
Applicant – READ THESE
PARAGRAPHS BEFORE SIGNING Top Brass, Inc.
I understand Top Brass, Inc. is an Equal Opportunity employer. Accordingly, Top Brass, Inc. does not discriminate against any applicant or employee because of race, color, religion, sex, sexual preference, pregnancy, national origin, age, marital status, ancestry, disability, or other basis prohibited by federal or Wisconsin law.
I understand Top Brass, Inc. hires on an employment-at-will basis. This means an employee may terminate his or her employment at any time with or without notice. Similarly, Top Brass, Inc. may terminate an employee’s employment at any time for any reason. This policy may not be changed except in writing signed by the president of Top Brass, Inc.
I understand this Application is not a contract or guarantee of employment.
I understand this Application may be considered for a period of one year. After that time, a new application must be submitted for continued consideration.
I understand Top Brass, Inc. may thoroughly investigate my work and personal history and verify all information given in the Application, any related papers, and interviews. I authorize individuals, schools, and employers named in any information I have given, except my current employer, unless otherwise permitted, to provide any information requested about me. I release them from all liability for damages in providing such information.
I represent that all information given in this Application, any related papers, and any interview is complete and accurate. I understand that if any such information is found to be false or if material information in intentionally omitted, adverse employment action, including termination, may occur.
I understand a drug test will be required as a condition to my employment. If an offer is received, I will execute a written consent for such drug test.
_________________________________________________________
Name of Applicant (Print)
_________________________________________________________
Signature of Applicant
_________________________________________________________
Date