EMPLOYMENT APPLICATION

Transcription

1 EMPLOYMENT APPLICATION The Goodyear Tire & Rubber Company is an Equal Opportunity Employer. The Goodyear Tire & Rubber Company does not discriminate in employment on the basis of race, color, religion, sex, sexual orientation, national origin, age, disability, veteran status, or any other characteristic prohibited by applicable Federal, State or local law. Personal Information NAME First Name: Jay Last Name: Imerman Middle Name: Joseph Name-Suffix: Preferred Name: Date of Application: Apr 16, 2013 PREVIOUS NAME(S) (Include maiden name) First Name: Last Name: Middle Name: Date(s) of change: (MM/YYYY) PRESENT ADDRESS Country: United States Mailing Street: 4067 Highview Court City: Waterford State: Michigan Zip: Telephone No.: Cell Phone No.: PERMANENT ADDRESS Mailing Street: City: State: Zip: Core Questions Are you 18 years of age or older? Yes How did you hear about The Goodyear Tire & Rubber Company? Have used their products on my vehicles for years Date available to begin work? Jun 17, 2013 Approximate salary expected: (If applying for an hourly position, please provide expected hourly rate; if applying for a salaried position, please provide expectation annual salary) 150,000 (You must enter a dollar amount; Negotiable will not acceptable) Type of work desired? Full time Terminations/Convictions In the last seven years, have you been involuntarily terminated (fired) (or resigned in lieu of being terminated) from any employment relationship? The questions seeking information on criminal convictions should NOT be answered by Massachusetts or Hawaiian applicants in any state where such questions are prohibited. Yes Where: RAND Worldwide Reason: RAND closed their PLM division and laid off all employees in that business. Have you EVER been convicted of or pleaded guilty to any crime other than minor traffic offenses? No If yes, list city, state, date and what offense for all: FAILURE TO PROVIDE A COMPLETE AND ACCURATE RESPONSE WILL BE CONSIDERED FALSIFICATION AND PREVENT YOU FROM BEING EMPLOYED AT The Goodyear Tire & Rubber Company. IF YOU HAVE ANY QUESTION ABOUT WHETHER AN OFFENSE SHOULD BE DISCLOSED, PLEASE ASK. U.S. Military Background

2 If military background does not apply to you leave this section blank BRANCH OF SERVICE Branch: From: To: IT-Product Lifecycle Management Application Development Architect Enovia - Akron Tech Center [N101]

3 Former Employee Are you a former employee of The Goodyear Tire & Rubber Company? No Job Title: Business Unit: Last Location: From: To: Reason for leaving: Driver's License Do you currently have a valid driver's license? Yes State: Michigan DL Number: I Expiration Date: May 18, 2016 Do you currently have a valid CDL? No State: CDL Number: Expiration Date Previous Employers (1) Present or Past Present Company Name: Inceptra LLC Employer Type: All other types Position Type: Direct Hire Country: United States Street: 2020 Northwest 150th Avenue City: Pembroke Pines State: Florida Zip: Reference Name: N/A Phone No.: (954) Start Month: (Enter 2 digits: MM) 04 Start Year: (Enter 4 digits: 2010 YYYY) End Month: (Enter 2 digits: MM) End Year: (Enter 4 digits: YYYY) Title: Senior PLM Solutions Architect Job Duties: Reason for leaving job (if not a present employer, please explain): Dan J. Smith No Starting Salary: Ending Salary: Previous Employers (2) Present or Past Present Company Name: JLI Enterprises LLC Employer Type: Self employeed Position Type: Direct Hire Country: United States Street: 4067 Highview Court City: Waterford State: Michigan Zip: Reference Name: Jay imerman Phone No.: Start Month: (MM) 05 Start Year: (YYYY) 1997 End Month: (MM) End Year: (YYYY) Title: President Job Duties: Reason for leaving job (explain): Nobody Yes Starting Salary: N/A Ending Salary: N/A Previous Employers (3)

4 Present or Past Past Company Name: RAND Worldwide Employer Type: All other types Position Type: Direct Hire Country: United States Street: 161 Worcester Rd Suite 401 City: Framingham State: Massachusetts Zip: Reference Name: Joe Oswald Phone No.: Unknown Start Month: (Enter as 2 digits: MM) 03 Start Year: (YYYY) 2005 End Month: (Enter as 2 digits: MM) 03 End Year: (YYYY) 2010 Title: Senior PLM Solutions Architect Job Duties: Presales, Postsales Reason for leaving job (explain): Department was closed and all employees laid off George Mallory Yes Starting Salary: Ending Salary: IT-Product Lifecycle Management Application Development Architect Enovia - Akron Tech Center [N101]

5 Previous Employers (4) Present or Past NA Company Name: Employer Type: Position Type: Country: Street: City: State: Zip: Reference Name: Phone No.: Start Month: (MM) Start Year: (YYYY) End Month: (MM) End Year: (YYYY) Title: Job Duties: Reason for leaving job (explain): Starting Salary: Ending Salary: Previous Employers (5) Present or Past NA Company Name: Employer Type: Position Type: Country: Street: City: State: Zip: Reference Name: Phone No.: Start Month: (MM) Start Year: (YYYY) End Month: (MM) End Year: (YYYY) Title: Job Duties: Reason for leaving job (explain): Starting Salary: Ending Salary: Previous Employers (6) Present or Past NA Company Name: Employer Type: Position Type: Country: Street: City: State: Zip: Reference Name: Phone No.: Start Month: (MM) Start Year: (YYYY) End Month: (MM) End Year: (YYYY) Title: Job Duties: Reason for leaving job (explain): Starting Salary: Ending Salary: IT-Product Lifecycle Management Application Development Architect Enovia - Akron Tech Center [N101]

6 Previous Employers (7) Present or Past NA Company Name: Employer Type: Position Type: Country: Street: City: State: Zip: Reference Name: Phone No.: Start Month: (MM) Start Year: (YYYY) End Month: (MM) End Year: (YYYY) Title: Job Duties: Reason for leaving job (explain): Starting Salary: Ending Salary: Education CHOOSE HIGHEST SCHOOL YEAR COMPLETED High School: 12 College: 4 Business: Trade School: Graduate School: HIGH SCHOOL Name: West Bloomfield High School Location: (City, State/Province/Country) West Bloomfield, MI Status of Degree: Degree/GED completed POST HIGH SCHOOL EDUCATION Name: University of Michigan Location: (City, State/Province/Country) Dearborn, MI From: (MM/YYYY) 09/1990 To: (MM/YYYY) 12/1993 Type of Degree: BS Status of Degree: Degree Completed GPA: 3.8 Major: Computer Science POST HIGH SCHOOL EDUCATION Name: Location: (City, State/Province/Country) From: (MM/YYYY) To: (MM/YYYY) Type of Degree: Status of Degree: GPA: Major: POST HIGH SCHOOL EDUCATION Name: Location: (City, State/Province/Country) From: (MM/YYYY) To: (MM/YYYY) Type of Degree: Status of Degree: GPA: Major: LIST LANGUAGES OTHER THAN ENGLISH (Separate each language with a comma) Speak: French, German, Hebrew Read: Write: References BUSINESS/PROFESSIONAL REFERENCES RELATED TO PREVIOUS EMPLOYMENT (non relative) First Name: See CV Last Name: See CV Street: See CV City: See CV State: Michigan Zip: See CV Country: United States Company:See CV Position: See CV Phone No.: See CV Length of Acquaintance: See CV First Name: See CV Last Name: See CV Street: See CV City: See CV State: Michigan Zip: See CV Country: United States Company:See CV Position: See CV Phone No.: See CV Length of Acquaintance: See CV IT-Product Lifecycle Management Application Development Architect Enovia - Akron Tech Center [N101]

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8 Certification By Applicant I hereby apply for a position with The Goodyear Tire & Rubber Company and grant said company permission to contact any person, company or school listed herein or orally given as reference to request information regarding my application for employment. I release any such person, company or school from any and all liability on account of furnishing such information. I understand that my misrepresentation of the information provided herein or on any other documentation provided to The Goodyear Tire & Rubber Company shall constitute just cause for termination of the interview process or, if applicable, continued employment without prior notice. I understand that any employment pursuant to this application shall be subject to my passing the standard physical examination which includes drug testing for evidence of drug abuse as a condition of final acceptance for employment. I further understand that such employment is subject to receiving and retaining any required security clearance. I understand that any employment pursuant to this application is provided without any representation or commitment for unlimited employment. Employment Status Statement I hereby agree and affirmthat no promises or commitments regarding tenure of employment may be made to me by any personnel of The Goodyear Tire & Rubber Company. I am voluntarily seeking employment with The Goodyear Tire & Rubber Companyand I understand I am free to resign. Similarly, The Goodyear Tire & Rubber Company is free to conclude my employment at anytime with or without cause. I understand that established employment policies and practices or employer pension, welfare and benefit programs of the Company are subject to modification or elimination at the discretion of the Senior Vice President, Human Resource or his/her success or designated Human Resource Division agents. Furthermore, I understand no other personnel of The Goodyear Tire & Rubber Company have the authority to make any representations that establish any specific period of employment, or conflict with, deviate from or are inconsistent with such personnel or benefit matters. I further understand that any employment pursuant to this application is conditioned upon my providing proof of lawful authorization to work in the United States. Disclosure Statement I understand that The Goodyear Tire & Rubber Company is unwilling to employ me unless I first fully disclose to it certain information. This includes all current agreements I may have with my prior employers or other relating to any of the following: 1. Restrictive covenants (promises not to compete, etc.); 2. Confidential information or trade secrets of others; 3. Inventions or patents; 4. Computer code I have written; or 5. Copyrights to my works or writings. I certify that I have provided The Goodyear Tire & Rubber Companywith copies or full written descriptions of all such agreements having any provisions still in effect. I further certify that I have not made any other agreements that could adversely affect The Goodyear Tire & Rubber Company business or legal interests regarding the items listed above. I understand that the content or scope of any such agreement may affect The Goodyear Tire & Rubber Company willingness to employ me. Failure by me to have fully disclosed any of such agreements The Goodyear Tire & Rubber Company may believe to be significant shall be cause for The Goodyear Tire & Rubber Companyto terminate my employment. I understand that unless or until a final offer of employment is made, I should not take any action which could result in financial loss if a contingent offer is withdrawn, such as giving notice of intent to terminate current employment, selling real estate, or incurring any other costs associated with accepting employment with The Goodyear Tire & Rubber Company. No such activity should be undertaken until after medical clearance and notification of a successful background investigation has been received and I receive a final offer of employment. Acknowledgement I have read and fully understand the information and the questions in this application. To the best of my knowledge, all the information listed on this application and accompanying material, if any, is complete, true, and accurate. I understand that any incomplete or false statements, misrepresentations, or omissions of fact may disqualify me for employment or, if I am hired, may result in termination of my employment without notice. After submitting your application, if you wish to withdraw your consent or you wish to obtain a copy of your application, you can contact us toll-free at Electronic Signature (Enter your name first and last exactly as you entered it in the personal information section of the application): I authorize my Electronic Signature: Accepted Date: Apr 16, 2013

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10 Consumer Authorization I hereby authorize and request The Goodyear Tire & Rubber Company and its designated representatives and agents, any consumer reporting agency or others having knowledge concerning my criminal conviction history, driving history, professional or business references, education verification, employment verification and identity verification (social security number verification) to furnish bearer with such information in connection with an application for employment. I am willing that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written notice from those who may provide information based upon this authorization request. I have been given a stand-alone consumer authorization form that a report may be requested for the reason shown above. Electronic Signature (Enter your name first and last exactly as you entered it in the personal information section of the application): I authorize my Electronic Signature: Accepted