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Application for Employment

Application Certification and Agreement

Please read carefully!

CERTIFICATION OF TRUTHFULNESS. I certify that all statements on the Application for Employment are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed or if employed may result in my dismissal.
AUTHORIZATION FOR EMPLOYMENT/EDUCATIONAL INFORMATION. I authorize the references listed in the Application for Employment, and any prior employer, educational institution or any other persons or organizations to give this Company any and all information concerning my previous employment/educational accomplishments, disciplinary information or any other pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I hereby waive written notice that employment information is being provided by any person or organization.
EMPLOYMENT AT WILL. If I am hired, in consideration of my employment, I agree to abide by the rules and policies of Ashley Industrial Molding, including any changes made from time to time, and agree that my employment and compensation can be terminated with or without cause, with or without notice, at any time, at the option of either Ashley Industrial Molding, Inc. or myself.
I understand that no officer, manager or supervisor of Ashley Industrial Molding, other that the President, has any authority to enter into any agreement for employment for any specific or indefinite period of time or to make any agreement contrary to the foregoing. Any such agreement made by the President must be made in writing to be effective.
NEED FOR ACCOMMODATION. If I am a person with a disability who requires accommodation to perform the job, I must notify Ashley Industrial Molding of this need.
CRIMINAL RECORDS CHECK. I authorize Ashley Industrial Molding to secure a criminal conviction history from the appropriate law enforcement agencies, should the Company determine it is necessary to do so.
PHYSICAL EXAM AND RELEASE OF MEDICAL INFORMATION. I agree to take a physical exam following a job offer conditioned on passing a physical exam. I authorize every medical doctor, physician or other healthcare provider to provide any and all information, including but not limited to all medical reports, laboratory reports, X-rays or clinical abstracts relating to my previous health history or employment in connection with any examination, consultation, test or evaluation. I hereby release every medical doctor, healthcare personnel and every other person, firm, officer, corporation, association, organization or institution which shall comply with the authorization or request made in this respect from any and all liability. I understand that this release will not be sent to my physician or other healthcare provider until a job offer has been made.
DRUG AND ALCOHOL TESTING. I agree to provide Ashley Industrial Molding with appropriate specimens to determine or exclude the presence of alcohol, drugs and other substances. I understand that decisions concerning my employment will be made as a result of this test.
CONSIDERATION FOR EMPLOYMENT. I understand that my application will be considered pursuant to the Company’s normal procedures for a period of sixty (60) days. If I am still interested in employment thereafter, I must reapply.
AUTHORIZATION TO WORK. If I am selected for hire I will be offered employment provided I verify that I am authorized to work as required by the Immigration Reform and Control Act of 1986.
LIMITATION ON CLAIMS. I agree that any action or suit against the Company arising out of my employment or termination of employment, including but not limited to claims arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claim or be forever barred. I waive any statute of limitation to the contrary.

I have read and understand items 1 through 10 above and acknowledge that with my signature below.

Signature*

Date*

/ /

*It is the policy of this Company not to discriminate in its employment and personnel practices because of a person’s genetic information, race, color, religion, sex, age, national origin, disability or any other status protected by applicable law.

Application for Employment

(PRE-EMPLOYMENT QUESTIONNAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)

General Information

Location

Ashley, IN Kendallville, IN Oelwein, IA

Date

Last Name

First Name

Middle Name

Present Address

Address

City

State

Zip

Telephone

Email Address

Do you have a legal right to work in the U.S. either as a U.S. citizen or authorized alien?

Yes No

Are you age 18 or older?

Yes No

Is there any additional information relative to a different name necessary to check your work and/or education record?

Yes

Other Information

Have you ever been convicted of any crime other than a routine traffic offense?

Yes

If yes, describe each (include all convictions, any plea of "no contest" or "guilty" unless expunged)

Are you presently on parole or probation?

Yes

Are you currently under indictment, arraignment or other criminal charge?

Yes

If yes, describe

Education

Type of School	Name	Location	Numbers of Years Completed	Type of Degree
High School
College
Vocational School

Work History

List Most Recent Job First

Name of Employer

Address

City

State

Zip Code

Phone number

Employment Dates

Pay or Salary

Start Final

Name of Last Supervisor

Your Last Job Title

Reason for leaving (Be Specific)

Please upload any related files:

(Click to add more work experience)

U.S. Armed Forces Service?

Yes

Branch of Service

Duties

Rank or rating at time of discharge

Military discharge status

References:

Do not list Relatives

Name	Address	Phone	How do you know this person?

List any professional and association memberships and licenses or certifications you may have. (NOTE: You need not list those which indicate race, color, religion, sex, national origin, age, disability or any other protected classification.)

List any other skills or qualifications you feel would be helpful for consideration of employment. (Include any machines or equipment you can set up and operate.)

Indicate any employers you do not wish us to contact and why

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