Employment Application – Kelley Ironworks

Section One: Personal information

First Name

Middle Name

Last Name

Street Address

City

State

Zip

Phone Number

Driver's License Number

Position you are applying for

Desired Salary

Can you travel, if required?

Yes No

Are you under 18 years of age?

Yes No

If under 18, can you provide a work permit?

Yes No Does not Apply

Applying for

Full Time Part Time Temporary

Are you currently employed?

Yes No

If employed, why do you wish to change?

Have you applied for employment here before?

Yes No

Have you ever been employed here before?

Yes No

Do you have experience working in the building materials industry?

Yes No

On what date would you be available to start work?

May we contact your present and previous employer(s)?

Yes No

How did you learn about this company?

Have you been convicted of a felony in the last 7 years?

Yes No

If not a US citizen, can you provide documentation of employment authorization?

Yes No Does Not Apply

Section two: Education

High School Name

High School Location

Did you graduate?

Yes No

College Name

College Location

Major Field of Study

Did you graduate?

Yes No

Other Degree/Certification Name

Other Degree/Certification Location

Major Field of Study

Did you graduate?

Yes No

Activities and Other Involvement

Section Three: Military Status

Branch of Service

Rank Upon Entry

Rank Upon Release

Nature of Duties

What specialized training did you receive?

Do you have any reserve or National Guard obligation?

Yes No

If yes, please describe:

Section Four: Employment History

If records are under a different name, please provide name for reference purposes, starting with present or last employer. List all employment including part-time or temporary positions.

EMPLOYER ONE

Employer

Phone

Start Date

End Date

Street Address

City

State

Zip

Name of Supervisor

Reason for leaving

Title and Duties

EMPLOYER TWO

Employer

Phone

Start Date

End Date

Street Address

City

State

Zip

Name of Supervisor

Reason for leaving

Title and Duties

EMPLOYER THREE

Employer

Phone

Start Date

End Date

Street Address

City

State

Zip

Name of Supervisor

Reason for leaving

Title and Duties

Section Five: Special Skills & Qualifications

Please list your skills and qualifications that you think would be valuable in this position:

Section Six: Disclosures

Note to Applicants: Do not answer yes or no to this question unless you have been informed about the requirements of the job for which you are applying—

Are you capable of performing in a reasonable manner, the essential functions involved in the job or occupation for which you have applied?

Yes No Does not apply

A description of the job functions involved in this job or occupation will be given to you upon receipt of this completed application.

You are not required to disclose information about physical or mental limitations that you believe will not interfere with your capability to do the job. However, if you want the employer to consider special arrangements to accommodate a physical or mental impairment, you may identify that impairment in the space provided below and suggest the kind of accommodation that you believe to be appropriate.

Section Seven: Agreements

I understand that, if hired, my employment will be "at will" and that either I or the company may terminate the employment relationship at any time with or without cause and with or without notice. I further understand that this employment relationship may not be modified by verbal statements, customs, practices, or written documents unless such modification is in writing and signed by an authorized representative of the company.

Yes, I understand No

In connection with my application for employment, I authorize this prospective employer to contact any or all previous employers to discuss my employment history, including reasons for termination of past employment. I also authorize this prospective employer to obtain a copy of my driving record from the Secretary of State or from the Secretary of State’s office in those states in which I held previous employment. I also authorize this prospective employer to confirm any or all information contained in this employment application. I certify that all information on this application is true and complete to the best of my knowledge, and I understand that falsification of any information on this application will be grounds for immediate discharge.

Enter your name if you agree with this statement:

Kelley Ironworks

Apply

Section One: Personal information

Section two: Education

Section Three: Military Status

Section Four: Employment History

Section Five: Special Skills & Qualifications

Section Six: Disclosures

Section Seven: Agreements

WBE Certified Business

DBE Certified Business

Apply

Section One: Personal information

Section two: Education

Section Three: Military Status

Section Four: Employment History

Section Five: Special Skills & Qualifications

Section Six: Disclosures

Section Seven: Agreements

Thanks for your application