Hourly Employment Application

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. WE DO NOT DISCRIMINATE WITH REGARD TO RACE, SEX, RELIGION, COLOR, NATIONAL ORIGIN, CITIZENSHIP, HANDICAP OR DISABILITY, AGE, OR ANY OTHER BASIS PROHIBITED BY LAW. WE ALSO PROVIDE REASONABLE ACCOMMODATIONS TO DISABLED INDIVIDUALS WHO CAN OTHERWISE PERFORM THEIR ESSENTIAL JOB FUNCTIONS. 
Personal Information
 
Last Name:      First Name:    Middle:
Street Address:
City, State, ZIP: , ,
Home Phone:
Business Phone:
Date: Position Applied for:
Have you ever applied for employment with us?  
Yes    No          If yes:   Month     and Year 
Salary Expected: 
Apart from absence for religious observance, are you available for full time work?
Yes    No          If yes:    Month      and Year  
Email Address:
What shifts are you applying for?   1st   2nd   3rd    Weekends   Any
Are you on layoff or subject to recall?    Yes    No  
Are you legally eligible for employment in the United States?  Yes    No  
Are you 18 years old or older?   Yes    No  
How were you referred to Winsert Inc.?
Have you been convicted of a felony or misdemeanor, including pleas of guilty or no contest, in the past 7 years? Do not include convictions that have expunged or sealed.   Yes    No  

If yes, please state the nature of the crime, when and where convicted.
(Note:  Applicants who have been convicted of a criminal offense will not automatically be denied employment. The conviction will only be considered as it relates to the duties of the job)

Incomplete applications will not be considered:
Education and Training

Name and Address of High School:

Dates Attended:
Diploma - Types of Degree or Certificate:
Colleges, Vocational or Technical Schools, Training Centers:
Major Subject:
Units:
Type of Degree or Certificate:
Dates Attended: 
   
LICENSES AND CERTIFICATES REQUIRED FOR, OR RELATED TO, POSITION APPLYING FOR
Description:
Issued By:
ID#:
Expiration Date
   
MILITARY SERVICE
Branch of US military service:
Service Date(s)    from:     to:
Grade of Rank at Discharge:
Applicable Military Experience:
Pertinent Special Skills
Please list experience with machines, office equipment, languages, or other special skills pertinent to the position for which you are applying
   
BUSINESS AND PROFESSIONAL REFERENCES
Please give the names of three references who have given you their permission to contact.
We must have at least two former supervisors and preferably one professional contact at your workplace.
No personal references please.
Reference #1 - Name:
Organization/Relationship:
Phone:
   
Reference #2 - Name:
Organization/Relationship:
Phone:
   
Reference #3 - Name:
Organization/Relationship:
Phone:
 
Record of Employment (list present or last employer first)

Present Employment #1

  
Company Name
Type of Business
Street Address
City, State, ZIP ,   
Telephone
Name and Title of Supervisor
Employed (state month and year) State:    From:     To:
Your title and brief description of your duties (do not put see resume)
Wage/Salary Range
Reason for leaving
 
Present Employment #2
Company Name
Type of Business
Street Address
City, State, ZIP ,    
Telephone
Name and Title of Supervisor
Employed State:    From:     To:
Your title and brief description of your duties (do not put see resume)
Wage/Salary Range
Reason for leaving
 
Present Employment #3
Company Name
Type of Business
Street Address
City State  ZIP ,    
Telephone
Name and Title of Supervisor
Employed State:    From:     To:
Your title and brief description of your duties (do not put see resume)
Wage/Salary Range
Reason for leaving
 
Present Employment #4
Company Name
Type of Business
Street Address
City State  ZIP ,    
Telephone
Name and Title of Supervisor
Employed State:    From:     To:
Your title and brief description of your duties (do not put see resume)
Wage/Salary Range
Reason for leaving
 

It is the Policy of Winsert Inc. to seek and employ the best qualified personnel, to provide equal opportunity for the advancement of Employees, including upgrading, promotion and training and to administer these activities in a manner which will not discriminate against any person because of race, color, religion, sex, sexual orientation, age, national origin, handicap, veteran status, disability or other protected categories in applicable federal, state or local laws.

JOB APPLICANT’S AGREEMENT (Read statement below carefully and sign)


I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any false statements, omissions, or misrepresentations on this application or false statements made during the employment process may be considered sufficient cause for rejection of this application or dismissal if I have been employed, no matter when discovered by the Company.

I hereby authorize Winsert, Inc. to thoroughly investigate my references, employment record and other matters related to my suitability for employment and, further authorize my former employers or any third party to disclose to the Company all reports and other information related to my suitability for employment, without giving me prior notice of such disclosure. In addition, I hereby release the Company, former employers and all references listed above, from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand that if offered a position, a condition of employment may be that I take a test for the purpose of detecting any drugs which might impair my ability to safely perform my job. I further understand that, should this test indicate the presence of drugs in my body, it may result in the rejection of my application for employment or my immediate discharge, if detected after hire. I consent to this testing and request that the results of such test(s) be disclosed to the Company and I hereby release the Company, its employees and agents, from any and all legal liability flowing from my taking such test(s) or my failure or refusal to take such test(s).

I understand that nothing contained in this application, or conveyed during any interview which may be granted, is intended to create an employment contract. I further agree that if I am hired, my employment is for no definite period and may be terminated at any time, without prior notice, at the option of either myself or the Company. I further understand that no representative of the Company has the authority to make any assurances to the contrary.

I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire me. If hired, I agree to abide by all Company work rules, policies and procedures relating to work performance and conduct.

THIS APPLICATION WILL BE KEPT ACTIVE FOR 30 DAYS. IF YOU ARE STILL INTERESTED IN EMPLOYMENT AFTER 30 DAYS, YOU MUST REAPPLY IN PERSON.

Signature: 
Date:        

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