Galion - Application For Employment

Applications are received and employees are hired without regard to race, creed, religion, color, sex, age, national origin, marital status, citizenship, or physical or mental disability.  In addition, we encourage the employment of veterans.  The receipt of this application does not mean that job openings exist and does not obligate us in any way.  We appreciate your interest in our organization.

AN AAP/ EQUAL OPPORTUNITY EMPLOYER -- DRUG FREE WORKPLACE -- WE DO DRUG TESTING

PERSONAL INFORMATION

Name:                    Social Security # XXX-XX-           Date:
            Last                                First                              Middle initial
Present Address:                    
                              No.                   Street Name                                  Building No.         City                                          State             Zip
How long have you lived at the above address?          Home or nearest phone:
Are you over the age of 18?  Yes    No    If no, employment is subject to verification that you are of minimum legal age.
Are you a U.S. citizen?  Yes    No    If not a U.S. citizen, can you provide proof that you can be legally employed in the U.S.? Yes    No   
EMPLOYMENT INFORMATION EDUCATION INFORMATION
Position applying for
Expected salary   Date available for work
Shift preference: 1st   2nd   3rd
Employment type: Full-time Part-time Seasonal Temporary
If part-time, what days?    hours?
Do you have reliable transportation to work? Yes    No
Have you ever applied for a job with us before? Yes    No
If yes, when?
Do you have relatives or friends who work for us? Yes    No
Have you ever been bonded? Yes    No
Have you ever been refused bond? Yes    No
If yes, when?
For what reason?

Have you ever been convicted of any crime other than a minor traffic violation or pled guilty, no contest, nolo contendere, had adjudication withheld or been placed in a pre-trail intervention program as a result of being charged with a crime? Yes    No
If yes, state offense, date, court and place where offense occurred
Have you ever had a position of trust (handling money or confidential Material? Yes    No
Are there any other experiences, skills or qualifications which you feel would especially fit you for work with this organization?
Do you know of any reason why you would not be able to perform the job for which you are applying, with or without a job modification or assistance?
Yes    No
If yes, describe 		Name of High School attended:
Did you graduate? Yes No    If no, highest grade completed

  Name Degree Graduate?
Trade\
Business
School		 Yes No
Yes No
Yes No
       
College\
University		 Yes No
Yes No
Yes No
       
Graduate
School		 Yes No
Yes No
Yes No
       




MILITARY SERVICE RECORD
Were you in the U.S. Armed Forces? Yes    No
Branch:
Dates of duty:           From            To
Rank at discharge
List duties in the Service including special training

PAST EMPLOYEMENT SECTION

LIST BELOW ALL PRESENT AND PAST EMPLOYMENT BEGINNING WITH YOUR MOST RECENT (Use Additional Attachments if Necessary)

1. From: (Mo/Yr)  
To:      (Mo/Yr) 
Position Held:     		Name and address of company:
 Supervisor:
Telephone:   		Start rate:
Last rate:  
Reason for leaving:
2. From: (Mo/Yr)  
To:      (Mo/Yr) 
Position Held:     		Name and address of company:
 Supervisor:
Telephone:   		Start rate:
Last rate:  
Reason for leaving:
3. From: (Mo/Yr)  
To:      (Mo/Yr) 
Position Held:     		Name and address of company:
 Supervisor:
Telephone:   		Start rate:
Last rate:  
Reason for leaving:
4. From: (Mo/Yr)  
To:      (Mo/Yr) 
Position Held:     		Name and address of company:
 Supervisor:
Telephone:   		Start rate:
Last rate:  
Reason for leaving:

May we contact the Employers listed above? Yes    No
If not, indicate by number which ones you do not wish us to contact:


ACCOUNT FOR ALL TIME YOU HAVE BEEN UNEMPLOYED SINCE LEAVING SCHOOL
From:     To: State what you were doing:
From:     To: State what you were doing:
From:     To: State what you were doing:
From:     To: State what you were doing:

This application will remain in the active file for thirty (30) days.   For consideration after the thirty day period, it is necessary to reapply.  This certifies that this application was completed by me, and all entries on it and information in it are true and complete to the best of my knowledge.  I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time.  I authorize the Company to investigate all statements contained in this application. I also authorize any contacted parties to give the Company any information they may have concerning my background.  I release all such parties from any liability which may arise from furnishing such information to the Company.  If my application is accepted for employment, I understand that I will be required to serve a 90 day orientation period.  I also understand and voluntarily agree that, as a condition of my employment or my continued employment, I may be requested by the Company to submit to a drug screen and that my failure to take such test when requested to do so, or my unsatisfactory test results, will disqualify me from consideration for employment or, if I am employed, may result in my immediate dismissal.  In consideration of my employment, I agree to conform to all of the Company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the Company's option. Employment at Galion is not guaranteed, contracted, or promised for any specific length of time.  I also understand and agree that the terms and condition of my employment may be changed, with or without cause and with or without notice, at any time by the Company.  I understand that no Company representative, other than its President, and then only when in writing and signed by the President, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.


APPLICANT SIGNATURE:       DATE:
                                         (sign by entering your full name)