Word Machinery Inc. - Employment Application

First Name:

Middle Initial:

Last Name:

Address:

City:

State:

Zip Code:

Phone #:

E-mail:

Are you over 18 years of age? Yes No

Can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.? Yes No

Have you ever been in the Armed Forces? Yes No

Are you an active member of the National Guard? Yes No

Additional Work Information

Desired Position:

How did you hear about this position?

Date you can start:

Desired Salary:

Employment Desired: Full Time Part Time Either

Ever applied with Word Machinery before? Yes No

If so, when?

Can you work weekends? Yes No

Are you willing to relocate? Yes No

Are you willing to travel if required? Yes No

Have you ever been convicted of a felony? Yes No

If yes, please explain:

Please Note: A criminal record does not constitute an automatic bar to employment and will be considered only as it substantially relates to the job in question.

Education

High School:

Did you graduate?

College:

Degree Obtained:

Trade School:

Did you graduate?

Work Related Skills:

Employment History

Please list previous employers, beginning with the most recent
You must complete this section even if attaching a resume.

Name of Employer:

Location (city/state):

Employed From (date):

Employed To:

Position:

Name of Supervisor:

Phone Number:

Rate of Pay:

Reason for Leaving:

Name of Employer:

Location (city/state):

Employed From (date):

Employed To:

Position:

Name of Supervisor:

Phone Number:

Rate of Pay:

Reason for Leaving:

Name of Employer:

Location (city/state):

Employed From (date):

Employed To:

Position:

Name of Supervisor:

Phone Number:

Rate of Pay:

Reason for Leaving:

References

Name:

Relationship:

Phone Number:

Years Known:

Address:

Name:

Relationship:

Phone Number:

Years Known:

Address:

Name:

Relationship:

Phone Number:

Years Known:

Address:

Authorization

Did you complete this application yourself? Yes No

If not, who did?

In exchange for the consideration of my job application by Word Machinery (hereinafter called "the Company"), I agree that:

"Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of the Company, or otherwise to change in any respect employment-at-will relationship between it and the undersigned, and the relationship cannot be altered except by a written instrument signed by the President or General Manager of the Company. Both the undersigned and the Company may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies, and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others and hereby release the Company from any liability as a result of such contact.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I further understand that my employment with the Company shall be introductory for a period of sixty (60) days, and further that at any time during the introductory period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

If I become employed at Word Machinery I understand that the following are not allowed inside company buildings: cell phones, pagers, wireless communication devices, USB Jump Drives, PDA's, flash disk, or any other communication device that has the ability to transfer any information.

I certify that the facts contained in this application are true to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Attach Resume File Upload:

Word Machinery is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age, or disability. Employment at Word Machinery depends solely on your qualifications.

Application Form

Personal Information

Additional Work Information

Education

Employment History

References

Authorization