Hourly Employment Application
Winsert Inc. is an Equal Opportunity Employer. Winsert doesn't discriminate in hiring because of age, race, creed, color, national origin, sex, religion, disability, veteran status or handicaps. 
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  
Other names you are known by
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)
It is the practice of Winsert Inc. to accept Applications for Employment for existing vacancies only.  You must submit a separate application for each position for which you desire to be considered.  Your application will be valid for up to 1 year.  Complete information should be furnished in order that we may give you fair and appropriate consideration.  As an Equal Opportunity Employer, it is the policy of Winsert Inc. to afford equal employment opportunity for all individuals and 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 regardless of race, color, religion, sex, national origin, handicap, disability, veteran status, creed or age.

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 am not acting as an agent of any individual, organization or agent to ‘test’ the lawfulness of propriety of Winsert Inc.’s hiring policies or practices.

I certify that the facts presented on this application are true and complete to the best of my knowledge. I understand and agree any misrepresentation or omission may result in denial of my application and that, if I am accepted as an Employee of Winsert Inc. and any facts presented to Winsert either on this application, resume or while employed, are found to be untrue or incomplete, disciplinary action may be taken which may result in termination. I authorize all corporations, companies, educational institutions, medical institutions, persons, law enforcement agencies, military services and former employers to release any information they may have about me to Winsert, and/or any agency acting as an agent of Winsert for the purpose of a pre-employment background check and/or consumer report. I release all parties from all liability for any damage that may result from furnishing same to Winsert.

I understand that Winsert’s policy forbids Employees to participate in enterprises which might (1) divert business opportunities from Winsert or (2) occupy so much of the Employee’s time or efforts as to detract from the Employee’s performance of his/her duties for Winsert. I understand that, should I become an Employee of Winsert, my employment relationship will be of an ‘at will’ nature which allows either party to terminate the relationship at any time. Specifically, I recognize that I may resign at any time with or without reason, or the company may discontinue my employment at any time with or without cause.

I hereby voluntarily agree to submit to any pre-employment or employment surveys or examinations as a condition of employment with Winsert. I release and agree to hold harmless Winsert, its Employees and its agents, from any and all liability, any claims of and any nature whatsoever that may arise from or be related to the surveys or examinations or the use of such survey or exam results.

My signature below indicates that I have read, understood, authorize and consent to all of the above and hereby voluntarily agree to participate in the drug and/or alcohol screening program.

Signature: 
Date:        

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