Iroquois Employment Application

Personal Information

Date of Application * +

First Name *

Last Name *

Middle Name

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Position Applying for *

Date Available * +

Salary Expected *

Shift Preference

Location Preference

Are you presently employed?

If Yes, where?

Have you ever worked at T&D? *

If Yes, when?

Are you at least 18 year old? *

Are you authorized for employment in the United States? *

How did you hear about us?

List the names of friends or relatives with the company:

Are you able to perform the essential functions of the specific position for which you are applying with or without reasonable accommodation? *

Education

High School Attended *

Address

Number of years attended: *

Did you graduate? *

If yes, list degree(s) earned:

Areas of Specialization

College Attended *

Address

Number of years attended:

Did you graduate?

If yes, list degree(s) earned:

Areas of Specialization

Graduate School Attended

Address

Number of years attended:

Did you graduate?

If yes, list degree(s) earned:

Areas of Specialization

What foreign languages do you speak or write?

Other formal education or experience which you believe is relevant to the position for which you are applying:

Employment References

List ALL employers worked for over the last five years, starting with the most recent employer first.

Name of Company

Address

Telephone Number

Start Date +

End Date +

Name of Supervisor

Starting Salary

Ending Salary

Position

Duties and Responsibilities

Reason for Leaving

Name of Company

Address

Telephone Number

Start Date +

End Date +

Name of Supervisor

Starting Salary

Ending Salary

Position

Duties and Responsibilities

Reason for Leaving

Name of Company

Address

Telephone Number

Start Date +

End Date +

Name of Supervisor

Starting Salary

Ending Salary

Position

Duties and Responsibilities

Reason for Leaving

Personal References

Name

Address

Telephone Number

Occupation

Relationship

Years Acquainted

Name

Address

Telephone Number

Occupation

Relationship

Years Acquainted

Applicant's Acknowledgement

I certify that the information furnished on this application is complete and correct. I understand and agree that any falsification, misrepresentation, misleading statements, or omission of facts on either this application or during the pre-hire process could result in (1) my not being offered employment; or (2) dismissal at any time from the service of the Company if employed. I may also be required to submit to physical examinations and other tests during my employment, including drug and/or alcohol testing.

I authorize my former employers to provide T&D Metal Products any information regarding my employment records, including and in addition to the above information and I release all parties from any liability for any damages that may result from furnishing such information. I also agree to conform to Company policies and regulations if employed.

I understand and agree that should I be hired, I am an at-will employee and that my employment and compensation can be terminated, with or without notice and with or without cause, at any time, by either the Company or me. I further understand and agree that no Company employee or representative has the power or authority to enter into any agreement for employment (other than to inform me of the fact that I have been hired), or to make any representations or agreements, contrary to the foregoing, unless they are in writing and signed by the Company President.

I agree that in consideration of the Company’s review of my application and, if hired, my employment thereafter, that any claim or suit that arises from my application or employment with the Company must be brought within 180 days after the event(s) giving rise to the claim, or the time limit specified by statute, which ever period is shorter; except that any claim filed with the US Equal Opportunity Commission must be filed within 300 days after the event(s) giving rise to the claim. I waive any statute of limitations that exceed these time limits.

Signature *

clear

Application Date * +