SCHUETTE, INC. CENTRAL WISCONSIN FINISHING DIVISION APPLICATION FOR EMPLOYMENT

Transcription

1 SCHUETTE, INC. CENTRAL WISCONSIN FINISHING DIVISION APPLICATION FOR EMPLOYMENT Schuette, Inc. is an equal employment opportunity employer dedicated to a policy of non-discrimination in employment based upon an individual's race, color, creed, religion, age, sex, national origin, ancestry, marital status, sexual orientation or the presence of any non-job-related medical condition or disability. In reading and answering the following questions, please keep in mind that none of the questions are intended to imply any limitations, illegal preferences or discrimination based upon any non-job-related information. This application will be given consideration, but its receipt does not imply that the applicant will be interviewed or employed. Please contact the Human Resource Department if you need an accommodation to participate in the application process at ext POSITION APPLIED FOR: Date Available to Start Work: PERSONAL DATA Name Address Street Address City State Zip Daytime Phone: Evening Phone: ( ) ( ) Area Code Area Code GENERAL INFORMATION 1. Have you ever applied for a job with this company in the past? If yes, please give the date of application, the position for which you applied and state your name at that time, if different from present name. 2. Have you ever been employed by this company in the past? If yes, please give dates of employment, positions held and state your name while employed, if different from present name. 3. If hired, will you be able to work during the normal days and hours required for the position(s) for which you are applying? If no, please explain: 4. Do you have any commitments to another employer that might affect your availability for employment with our company? If yes, please explain: 5. If hired, can you furnish proof that you are 18 years of age, or if under 18, do you have a permit to work? If no, please explain: 6. If hired, can you furnish proof that you are eligible to work in the United States? (If unsure of the documents needed to prove eligibility to work in the U.S., we will be happy to explain the legal requirements.) If no, please explain:

2 7. Do you now, or will you in the future, require Schuette, Inc. to sponsor an employment visa for your continued employment? 8. Have you been convicted of a felony, or released from prison in the past 10 years? te: A yes answer does not automatically disqualify you from employment since the nature of the offense, date and type of job for which you are applying will be considered. If yes, please explain: 9. Are you charged with an unresolved criminal charge (have you been charged with a crime that has not yet resulted in a plea of guilty, court trial or dropping of the charge)? te: A yes answer will not automatically disqualify you from employment. If yes, please explain: DO NOT ANSWER QUESTIONS 10 OR 11 IF A JOB DESCRIPTION IS NOT ATTACHED! 10. Are you able to perform the tasks listed on the attached job description with or without an accommodation? 11. If necessary, what accommodation could we make that would allow you to perform the essential functions of the job? EDUCATIONAL DATA SCHOOLS ATTENDED NAME OF SCHOOL AND LOCATION DID YOU GRADUATE? YES NO DEGREE/ DIPLOMA/ CERTIFICATE? MAJOR COURSE OF STUDY HIGH SCHOOL CIRCLE HIGHEST GRADE COMPLETED TECHNICAL VOCATIONAL BUSINESS OR MILITARY TRAINING COLLEGE OR UNIVERSITY GRADUATE SCHOOL PROFESSIONAL SEMINARS Additional JOB-RELATED seminars, short courses, workshops or other educational experiences: JOB-RELATED certificates, licenses, equipment qualified to operate, computer hardware and software operated and other JOB-RELATED special skills and abilities:

3 EMPLOYMENT HISTORY PRESENT & FORMER EMPLOYERS List Present or Most Recent Employer First - Please complete even if a resume is attached. Attach additional sheet if necessary. Company Name Dates of Employment From To Address Supervisor (and phone number, if known) City, State, Zip Your name when employed, if different from present Job Title & Duties Reason for Leaving Final Salary: $ per May We Contact? Company Name Dates of Employment From To Address Supervisor (and phone number, if known) City, State, Zip Your name when employed, if different from present Job Title & Duties Reason for Leaving Final Salary: $ per May We Contact? Company Name Dates of Employment From To Address Supervisor (and phone number, if known) City, State, Zip Your name when employed, if different from present Job Title & Duties Reason for Leaving Final Salary: $ per May We Contact? Please account for any time you were not employed after leaving school in the past ten years. (You need not list any unemployment periods of one month or less) Time Period(s) Reason(s) for Unemployment If you were unable to list all past jobs or periods of unemployment on this form, please use an additional sheet.

4 REFERENCES - LIST THREE BUSINESS RELATED INDIVIDUALS THAT ARE NOT FORMER EMPLOYERS NAME ADDRESS CITY, STATE, ZIP PHONE NUMBER OCCUPATION OTHER JOB-RELATED EXPERIENCE. Some people gain job-related experience in positions other than as an employee. For instance, an accountant may gain experience as a treasurer of a civic or school organization, or a manager may gain experience while working on civic projects, in school organizations or in PTA activities. Please list and describe any paid or unpaid activities, honors, experience or training that might aid you in performing the job(s) for which you have applied, and have not been listed previously in this application. (You may omit any activities, honors, memberships or other items that tend to identify your race, sex, national origin, age, disability or other personal traits that you prefer not to disclose.) Please add any additional information (except that which identifies your race, sex, age, religion, national origin, disability or other non-jobrelated personal information) that you think may be relevant to a decision to hire you. How did you hear about Schuette, Inc.? (i.e., Current Employee, Internet, Workforce Development, etc.) IMPORTANT PLEASE READ CAREFULLY AND INITIAL EACH PARAGRAPH BEFORE SIGNING Initials By my signature and initials, I promise that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment by Schuette, Inc., if discovered at a later date. I agree to immediately notify Schuette, Inc. if I should be convicted of a felony, or any crime involving dishonesty or a breach of trust while my job application is pending, or during my period of employment, if hired. I authorize any person, school, current employer (except as previously noted), past employer(s), government or investigative agencies and other organizations that may be named in this application form (and accompanying resume, if any) to provide the company with relevant information, and opinion that may be useful to Schuette, Inc. in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements. I understand that, if hired, I may not hold other employment, nor engage in consulting, sales, investments or other activities that may create a conflict of interest with Schuette, Inc. I understand that if employed, and my employment is terminated by Schuette, Inc. for dishonesty, breach of trust or any criminal acts, the authorities may be notified, and I may be criminally prosecuted. I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time. I understand that only the President of Schuette, Inc. is authorized to change any of the terms of employment, and that any changes must be specific and in writing. Signed: Date

5 Schuette, Inc. Release of Information Authorization I hereby authorize Schuette, Inc., its employees and its agents, and its employees and authorized agents, to verify any information I have provided. In connection with, and duration of my employment (including contract for services) with you, I understand investigative background inquiries are to be made on myself including consumer, criminal, driving and other reports. These reports will include information as to my character, work habits, performance and experience, along with the reasons for termination of past employment from previous employers. Further, I understand you will be requesting information from various Federal, State and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences, as well as claims involving me in the files of insurance companies. All inquiries are subject to the provisions of the Fair Credit Reporting Act. I authorize my current and previous employers, educational institutions, banking and other financial institutions, credit rating bureaus or institutions maintaining individual credit rating files and governmental agencies or political subdivisions to give any information requested regarding my employment, character and qualifications. Any previous employer is also hereby authorized to release any and all documents which, by agreement with me, have been designated as confidential or sealed. I hereby expressly release and hold harmless Schuette, Inc., their agents, employees and any person or organization who provides information or records relating to me from any and all liability or claiming related to the investigation of my personal employment audit or financial history. I further agree to release and hold harmless, any person or entity which provides accurate and further information to Schuette, Inc., or its agents in the course of conducting a background check for purposes of employment with Schuette, Inc. This Release shall be valid for twelve (12) months immediately following the date of my signature below. In compliance with the Privacy Act of 1974, the following information is provided: The disclosure of your Social Security Number (SSN) is voluntary. However, failure to supply a SSN may result in errors in processing your application. A false statement or a material omission on any part of your application may be grounds for termination from employment. I have read, understood, and approve of the previous Privacy Act notice: Initials: Name (Please Print) Social Security Number (SSN) Previous Names/Maiden Names Current Address City/State/Zip Date of Birth Driver s License Number State Date Signature

6 Schuette Inc. Voluntary Self-Identification Survey Form Applicant Affirmative Action Employer TO ALL APPLICANTS: Our company is an Affirmative Action/Equal Employment Employer and as such, we are required to collect and maintain information related to applicants in order to meet governmental recordkeeping and reporting requirements and to monitor the effectiveness of our outreach, recruitment and other employment practices. At this time, we are asking you to help us meet our obligations by providing the information listed on the following pages. Please note that the information will be used only in accordance with the provisions of applicable laws, executive orders, and regulations. Providing this information is voluntary and refusal to so will not result in any adverse treatment. The information you provide will be held in strict confidence except that: 1) Necessary management and supervisory personnel may be informed to ensure proper placement and to provide reasonable job accommodations; 2) First aid and safety personnel may be informed to the extent appropriate, if the condition might require emergency treatment; and 3) Government officials investigating affirmative action program compliance may have access to reported information. Thank you for your cooperation in this important initiative. Schuette Inc.abides by the requirements of federal laws which prohibit discrimination and require affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified individuals with the following legally protected status: race, color, religion, sex, national origin (per Executive Order 11246), disability (per 41 CFR (a), and protected veterans (per 41 CFR (a). PART I. General Information Name: Position Applied for: Date: PART II: Referral Source: Please indicate how you heard about this opening Company website Job board Newspaper Temp agency Search firm Educational institution Walk-in Employee referral College Recruiting Professional Association State employment agency Other This sample document is only an example and is based on the laws in effect at the time it was written. MRA-The Management Association, Inc. does not make any representations or warranties regarding the appropriateness or prudence of using this information for any particular individual or situation. Your company should add, delete, or modify the content of this document as needed to suit your purposes. This material is for your information only and should not be construed as legal advice. In some circumstances it may be advisable to have legal counsel review final documents prior to implementation. For further assistance call or visit MRA The Management Association, Inc. Wisconsin: Minnesota rthern Illinois: Iowa & Western Illinois: Invitation to Identify - Applicants.doc Page 1 of 3 Rev. 08/11/2014

7 Con t. PART III. Gender, Ethnicity and Race Information: Gender CHECK ONE: Ethnicity CHECK ONE: Race CHECK ONE: (do not respond if you selected Hispanic or Latino above) Male Female I choose not to disclose this information Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race) t Hispanic or Latino (if not Hispanic or Latino, please address race below) I choose not to disclose this information White (t Hispanic or Latino): a person having origins in any of the original peoples of Europe, the Middle East, or rth Africa Asian (t Hispanic or Latino): a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam American Indian or Alaska Native (t Hispanic or Latino): a person having origins in any of the original peoples of rth and South America (including Central America), and who maintain tribal affiliation or community attachment Black or African American (t Hispanic or Latino): a person having origins in any of the black racial groups of Africa Native Hawaiian or Other Pacific Islander (t Hispanic or Latino): a person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands Two or More Races (t Hispanic or Latino): all persons who identify with more than one of the above five races I choose not to disclose this information Please continue to next page to identify veteran status. Invitation to Identify - Applicants.doc Page 2 of 3 Rev. 08/11/2014

8 Con t. PART IV. Protected Veterans The definitions of protected veterans are listed below. Use the boxes following the definitions to indicate whether you are a protected veteran Disabled Veteran A disabled veteran is one of the following: A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or A person who was discharged or released from active duty because of a serviceconnected disability. Recently Separated Veteran Active Duty Wartime or Campaign Badge Veteran Armed Forces Service Medal Veteran CHECK ONE: A recently separated veteran means any veteran during the three-year period beginning on the date of such veteran s discharge or release from active duty in the U.S. military, ground, naval, or air service. An active duty wartime or campaign badge veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An armed forces service medal veteran means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order I am a Protected Veteran I am not a Protected Veteran I choose not to disclose the information Invitation to Identify - Applicants.doc Page 3 of 3 Rev. 08/11/2014

9 Voluntary Self-Identification of Disability Why are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. i To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way. If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to: Blindness Autism Bipolar disorder Post-traumatic stress disorder (PTSD) Deafness Cerebral palsy Major depression Obsessive compulsive disorder Cancer HIV/AIDS Multiple sclerosis (MS) Impairments requiring the use of a wheelchair Diabetes Schizophrenia Missing limbs or Intellectual disability (previously called mental Epilepsy Muscular partially missing limbs retardation) dystrophy Please check one of the boxes below: YES, I HAVE A DISABILITY (or previously had a disability) NO, I DON T HAVE A DISABILITY I DON T WISH TO ANSWER Your Name Today s Date

10 Voluntary Self-Identification of Disability Reasonable Accommodation tice Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor s Office of Federal Contract Compliance Programs (OFCCP) website at PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.