APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, genetic information or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.

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Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT, except for signature on back of application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Job Applied for      Today’s Date

Are you seeking: Full-time   Part-time   Temporary Employment      When could you start work?

                              

Last Name                                        First Name                                        Middle Name                                     Telephone Number

                           

Present Street Address                                    City                                                             State                                  Zip Code

Are you 18 years of age or older? ................................................. Yes    No

(If you are hired, you may be required to submit proof of age.)

If hired, you will be required to furnish proof of your eligibility to work in the U.S.

 

Have you ever applied here before?        Yes         No          If yes, when? 

Were you ever employed here?        Yes         No          If yes, when? 

Have you ever been convicted of any law violation?
Include any plea of “guilty” or “no contest.” (Exclude minor traffic violations.) ........................... Yes 
No 

If yes, give details 

(A conviction will not necessarily disqualify an applicant for employment.)

If employed, do you expect to be engaged in any additional business
or employment outside of our job? ........................................................   Yes 
No 

If yes, give details 

 

 

For Driving Jobs Only: Do you have a valid driver’s license? ......................................   Yes  No

Driver’s License Number      Class of License      State Licensed In 

Have you had your driver’s license suspended or revoked in the last 3 years? ..................... Yes  No 

If yes, give details: 

List professional, trade, business or civic activities and offices held. (Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability, genetic information or other protected status.)

 

 

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LIST NAME AND ADDRESS OF SCHOOLS

Number of
Years
Completed

Diploma/
Degree/
Certificate

Subjects
Studied

High School or GED: 

College or University: 

Vocational or Technical: 

What skills or additional training do you have that relate to the job for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?


 

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List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers.

NAME OF EMPLOYER

JOB TITLE AND DUTIES

ADDRESS

DATES OF EMPLOYMENT: FROM  TO

CITY, STATE, ZIP CODE

PAY: START $ FINAL $

SUPERVISOR(S)

TELEPHONE

Reason For Leaving

NAME OF EMPLOYER

JOB TITLE AND DUTIES

ADDRESS

DATES OF EMPLOYMENT: FROM  TO

CITY, STATE, ZIP CODE

PAY: START $ FINAL $

SUPERVISOR(S)

TELEPHONE

Reason For Leaving

 

NAME OF EMPLOYER

JOB TITLE AND DUTIES

 

ADDRESS

DATES OF EMPLOYMENT: FROM  TO

 

CITY, STATE, ZIP CODE

PAY: START $ FINAL $

 

SUPERVISOR(S)

TELEPHONE

Reason For Leaving

 

NAME OF EMPLOYER

JOB TITLE AND DUTIES

 

ADDRESS

DATES OF EMPLOYMENT: FROM  TO

 

CITY, STATE, ZIP CODE

PAY: START $ FINAL $

 

SUPERVISOR(S)

TELEPHONE

Reason For Leaving

 

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Have you worked or attended school under any other names? ..................................   Yes  No 

If yes, give names:

Are you presently employed? .......................................................   Yes    No 

If yes, whom do you suggest we contact?

Have you ever been fired from a job or asked to resign? .....................................   Yes    No 

If yes, please explain:

Give three references, not relatives or former employers.

Name

Address

Phone

1.  

2.  

3.  

 

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

 

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

I have read, understand, and by my signature consent to these statements.

Digital Signature (Please type name):     Date:

This application for employment will remain active for a limited time. Ask the organization’s representative for details.

 

Please Print this Application before clicking "Send Application" in case the submission fails.

 

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Contact Details

Telephone: 1-800-229-9500
Fax: 1-800-229-9600
Email: sales@cbwautomation.com
Parts Order: orderparts@cbwautomation.com

3939 Automation Way
Fort Collins, CO
80525
USA