EMPLOYMENT APPLICATION

Transcription

1 EMPLOYMENT APPLICATION ***Applicants will be subject to Drug Screening & Criminal Background Check*** An Equal Opportunity Employer Medallion Athletic Products, Inc. is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicants requiring reasonable accommodation in the application and/or interview process should notify a representative of the organization. Please print and fill out all sections Applicant Information Applicant Name Home Phone ( ) Other ( ) Address Current Street Address City State & Zip How were you referred to Medallion Athletics? Employment Positions Position(s) applying for: Salary desired: Are You Applying For Regular full-time work? [ ] Y or [ ] N Regular part-time work? [ ] Y or [ ] N Temporary work - such as summer or holiday work? [ ] Y or [ ] N How many hours can you work weekly? Can you work nights? If hired, on what date can you start working? / / Are you available to work overtime? [ ] Y or [ ] N

2 Personal Information Do you have a valid Driver s License? Yes No Driver s License Number State of Issue Expiration Date Have you had any accidents during the past three years? How many? Have you had any moving violations during the past three years? How many? If hired, would you be able to present evidence of your proof of your legal right to work in the United States? [ ] Y or [ ] N Have you ever been convicted of a criminal offense (felony or misdemeanor)? [ ] Y or [ ] N If yes, please describe the crime - state the nature of the crime(s), when and where convicted and disposition of the case Education, Training and Experience High School: School Name: School Address: School City, State, Zip: Number of years completed: Did you graduate? [ ] Y or [ ] N Degree / Diploma earned: College / University: School Name: School Address: School City, State, Zip: Number of years completed: Did you graduate? [ ] Y or [ ] N Degree / Diploma earned: Vocational School: School Name: School Address: School City, State, Zip: Number of years completed: Did you graduate? [ ] Y or [ ] N Degree / Diploma earned? Military: Branch: Rank in Military: Total Years of Service: Skills/Duties: Related details: Are you now a member of The National Guard?

3 Do you speak, write or understand any foreign languages? [ ] Y or [ ] N If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be Do you have any other experience, training, qualifications, or skills which you feel we should know about, in case it makes you especially suited for working with us? [ ] Y or [ ] N If yes, please explain: Please list two references other than relatives or previous employers Name: Position: Company: Telephone: Name: Position: Company: Telephone: Other Information An application sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

4 Work Experience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, please give the company name. Name of Employer Name of Supervisor Address City, State, Zip Phone Number Employment Dates Starting Pay Final Pay Reason for leaving List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company Name of Employer Name of Supervisor Address City, State, Zip Phone Number Employment Dates Starting Pay Final Pay Reason for leaving List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company Name of Employer Name of Supervisor Address City, State, Zip Phone Number Employment Dates Starting Pay Final Pay Reason for leaving List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company

5 DRUG AND/OR ALCOHOL TESTING CONSENT FORM I,, hereby consent and agree to drug and/or alcohol testing as a condition of consideration for employment and/or continued employment with Medallion Athletic Products, Inc. (or the Company ). I understand that information regarding the test results may be used as grounds for adverse employment action, including denial of employment and /or termination of my employment with the Company. I further understand and acknowledge that: 1. The Company will pay the cost of all required drug and/or alcohol tests; 2. Test results will be released to Medallion Athletic Products, Inc. and may be used by the Company in determining any adverse employment action that may be taken against me; 3. If the laboratory results of my drug test indicate a positive result, I will have an opportunity to discuss and rebut that result by consulting with a Medical Review Officer; and that the Medical Review Officer will determine whether there is a legitimate medical explanation for any positive drug test; and 4. I have the right to refuse to submit to such testing; understanding, however, that my refusal to submit to or to cooperate with such testing shall be considered a refusal to submit to testing subject to denial of employment or termination in accordance with Medallion Athletic Products, Inc. Drug & Alcohol Policy. I agree that Medallion Athletic Products, Inc. has made no representations, inducements, or statements, other than those in writing, about testing, and that I consent to be tested. I hereby further certify that Medallion Athletic Products, Inc. has provided me with a copy of its Drug & Alcohol Policy; that I have read and do understand that Policy; and that I agree to abide by the terms and conditions of the Policy. Job Applicant/Employee Name: Date: Witness Name:

6 BACKGROUND CHECK CONSENT FORM I authorize Medallion Athletics to perform a Background Check and MVR Check as a Condition of Employment. Job Applicant s Name Job Applicant s Date of Birth Job Applicant s Signature Job Applicant s DL #