Online Employment Application * fields are required. Personal Information + Date*08/20/2017 First Name* Middle Initial and Last Name Home phone number (example: 555-555-5555) Cell phone (example: 555-555-5555) Email (example: myname@example.com) Street Address City, State and Zipcode* (example: Columbus, WI 53925) Is the address shown above your permanent address?(If No, fill in the next 4 fields below)YesNo Permanent Street Address City, State and Zipcode* (example: Columbus, WI 53925) Position Information + Position applying for Are you available to work Monday through Friday?YesNo If you answered No, please list days available Preferred Daily Shift Duration3-4 Hours per Day5-6 Hours per Day Desired Location(s)WestsideEastsideOther Desired Wage Available Hours per Week Restrictions on Available Hours or Days?YesNo If you answered Yes, please explain Are you currently working?YesNo How did you hear about us?AdvertisementEmployeeSchoolOther Referrers Name Personal History + Can you provide verification of your legal right to work in the US?YesNo Have you ever been convicted of any law violation other than minor traffic violations?YesNo If you answered Yes, please list date and nature of offenseThe conviction will only be considered if substantially related to the circumstances of the position. Attach additional sheets as necessary. Have you filed an application with us before?YesNo If you answered Yes, please list date(s): Have you ever been employed by this organization?YesNo If you answered Yes, please list dates and positions held: High School Education + Did you go to High School?YesNo Did you graduate?YesNo High School Name City, State (example: Columbus, WI) College/University Education + Did you go to College?YesNo Did you graduate?YesNo Academic Major College/University Name City, State (example: Columbus, WI) Degree Earned Did you attend a second college or university?YesNo Did you graduate?YesNo Academic Major College/University Name City, State (example: Columbus, WI) Degree Earned Did you attend a third college or university?YesNo Did you graduate?YesNo Academic Major College/University Name City, State (example: Columbus, WI) Degree Earned Other Education + Other Relevant Training Work Experience + List all employment experience with the most recent first. Company Title Address City, State and Zipcode (example: Columbus, WI 53925) Phone Number (example: 555-555-5555) Name under which you worked if different Salary Does the figure listed above represent an hourly or annual salary?YesNo Dates of Employment to (example: 01/01/2016) Did you work full time or part time?Full TimePart Time If part-time, how many hours per week? Supervisor Name Supervisor Title May we contact?YesNo Description of Duties: Reason for leaving Company Title Address City, State and Zipcode (example: Columbus, WI 53925) Phone Number (example: 555-555-5555) Name under which you worked if different Salary Does the figure listed above represent an hourly or annual salary?YesNo Dates of Employment to (example: 01/01/2016) Did you work full time or part time?Full TimePart Time If part-time, how many hours per week? Supervisor Name Supervisor Title May we contact?YesNo Description of Duties: Reason for leaving Company Title Address City, State and Zipcode (example: Columbus, WI 53925) Phone Number (example: 555-555-5555) Name under which you worked if different Salary Does the figure listed above represent an hourly or annual salary?YesNo Dates of Employment to (example: 01/01/2016) Did you work full time or part time?Full TimePart Time If part-time, how many hours per week? Supervisor Name Supervisor Title May we contact?YesNo Description of Duties: Reason for leaving References + Work Related References (other than immediate supervisor) Name Occupation Phone Number (example: 555-555-5555) Address City, State and Zipcode (example: Columbus, WI 53925) Name Occupation Phone Number (example: 555-555-5555) Address City, State and Zipcode (example: Columbus, WI 53925) Name Occupation Phone Number (example: 555-555-5555) Address City, State and Zipcode (example: Columbus, WI 53925) Applicant's Signature + Please read the paragraphs below very carefully before signing. I certify that my answers to the questions are true to the best of my knowledge and am aware that misrepresentation or omission of facts called for on this form is cause for rejection of my application or immediate discharge from the organization's service. I voluntarily give GAR Plastics the right to make a thorough investigation of my past employment, agree to cooperate in such investigation and release from all liability of responsibility all persons, companies or corporations supplying such information. I understand that this application for employment shall be considered active for a period of time not to exceed six (6) months. It is hereby understood and acknowledged that any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. If employed, I agree to work the hours, days and shifts as scheduled and consent to take the preplacement examination and such future physical examinations as may be required by GAR Plastics. Applicant Signature* Date*08/20/2017
