Guttenberg Industries Job Application
Job Application
Name
Last Name: *
First Name: *
Middle Name: *
Present Address
Where you are currently living
Present Address Street *
Present Address City *
Present Address State *
Present Address Zip Code *
Permanent Address
Your home of record
Permanent Address Street *
Permanent Address City *
Permanent Address State *
Permanent Address Zip Code *
Email
Phone number *
Are you 18 years or older? *
Are you a U.S. Citizen or an alien authorized to work in the United States? *
Employment Desired
Desired Position: *
Date you can start *
Salary Desired
Referred By
What is your shift preference? *
Are you employed now? *
Have you ever worked for Guttenberg Industries, Inc. before? *
Have you ever applied to our company before? *
If Yes, When?
Education
Grammar School
Name and Location of Grammar School *
No. of years attended *
Did you graduate? *
Subjects Studied
Education
High School
Name and Location of High School *
No. of years attended *
Did you graduate? *
Education
College
Name and Location of College *
No. of years attended
Did you graduate?
Clear selection
Subjects Studied
Education
Trade, Business, or Correspondence School
Name and Location of Trade, Business, or Correspondence School
No. of years attended
Did you graduate?
Clear selection
Subjects Studied
General Information
Exclude any information or organizations, the name of which, indicates the race, creed, sex, age, marital status, color or nation of origin of its members
Subjects of Special Study or Research Work
Special Skills
Activities: (Civic, Athletic, Etc.)
U.S. Military or Naval Service (include rank or pay grade)
Current or Most Recent Employer
Name and Address of Current or Most Recent Employer *
Dates of Employment (From - To) *
Position Duties *
Salary
Reason for Leaving *
Next Previous Employer
Name and Address of Previous Employer *
Dates of Employment (From - To) *
Position Duties *
Salary
Reason for Leaving *
Next Previous Employer
Name and Address of Previous Employer
Dates of Employment (From - To)
Position and Duties
Salary
Reason for Leaving
Next Previous Employer
Name and Address of Previous Employer
Dates of Employment (From - To)
Position and Duties
Salary
Reason for Leaving
References
Give the names of three persons not related to you, whom you have known at least one year.
Name of 1st Reference *
Address & Phone Number *
Business
Years Acquainted *
Name of 2nd Reference *
Address & Phone Number *
Business
Years Acquainted *
Name of 3rd Reference *
Address & Phone Number *
Business
Years Acquainted *
Do you have any impairments, physical or mental, which would interfere with your ability to perform the job for which you have applied? *
Have you ever been convicted of a felony? *
If "Yes" please explain
In Case of Emergency Notify
Name (In Case of Emergency Notify) *
Phone Number *
Address *
*I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
* I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you.
* I understand and agree that, if hired, my employment is for no definite period, and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause.
* NOTE: All employment offers will be contingent upon satisfactory completion of a pre-employment drug screening.
IMPORTANT: Guttenberg Industries requires that you certify your application by submitting an electronic signature. To certify your application, type your full name below and click the Confirm Signature & Submit Application button.
Date *
Name (electronic signature) *
NOTE: *The Age Discrimination in Employment Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age. This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.
Thank you for your interest in a career with Guttenberg Industries.
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