Utelite Application for Employment

AN EQUAL OPPORTUNITY EMPLOYER

Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, color, national origin, religion, age, sex, disability or any other factor prohibited by law or regulation.

Please fully and accurately complete each question. Incomplete applications may not be considered.

First Name (required)

Middle Name

Last Name (required)

Date

Phone (required)

Email (required)

Street

City

State

Zip

Position Desired

Salary or pay you expect

Date Available for Work

(1)

(2)

(3)

Do you have a valid drivers license? YesNo

Drivers License Number

Class of License

State Issued

Have you ever had your license suspended or revoked YesNo

If yes, give details

Are you presently employed?YesNo

Do you have to give advance notice to your present employer?YesNo

May we contact your present employer for a reference?YesNo

If requested would you be willing to take a drug/alchohol screening before and/or after employment as a condition of your employment?YesNo

Are you at least 18 years old?YesNo

If hired, can you furnish proof that you are eligible to work in the U.S.?YesNo

Have you ever worked or applied for work at this company before?YesNo

Have you ever been discharged for cause?YesNo

Have you ever been refused a surety bond or had one cancelled?YesNo

Have you ever been convicted of any law violation, except for minor traffic violation?(A criminal record does not automatically bar employment)YesNo

Have you ever been disciplined for abenteeism?YesNo

Have you ever been disciplined for tardiness?YesNo

If yes, give details

Check Your Highest Grade or Years Completed
—Please choose an option—12345679101112

College or Other
—Please choose an option—1234567

High School or GED

School Name & Location

Did you recieve a diploma?
—Please choose an option—YesNo

Grade Point Average

Major Subject(s)

Special Courses

College or University

School Name & Location

Did you recieve a diploma?
—Please choose an option—YesNo

Grade Point Average

Major Subject(s)

Special Courses

Graduate School

School Name & Location

Did you recieve a diploma?
—Please choose an option—YesNo

Grade Point Average

Major Subject(s)

Special Courses

Other Education

School Name & Location

Did you recieve a diploma?
—Please choose an option—YesNo

Grade Point Average

Major Subject(s)

Special Courses

Employment Record

Give a complete account of your employment. BEGIN ON THE FIRST LINE WITH YOUR PRESENT OR MOST RECENT EMPLOYMENT

1. Employer

Address

Phone

Main Duties

From

to

Starting Pay

Leaving Pay

Supervisor

What did you like about this job?

What did you dislike about this job?

Reason for leaving

2. Employer

Address

Phone

Main Duties

From

to

Starting Pay

Leaving Pay

Supervisor

What did you like about this job?

What did you dislike about this job?

Reason for leaving

3. Employer

Address

Phone

Main Duties

From

to

Starting Pay

Leaving Pay

Supervisor

What did you like about this job?

What did you dislike about this job?

Reason for leaving

Other positions (including periods of military/public services)

Employer

Main Duties

From

To

Pay

Reason for Leaving

Employer

Main Duties

From

To

Pay

Reason for Leaving

Employer

Main Duties

From

To

Pay

Reason for Leaving

APPLICANT AGREEMENT (Read carefully before signing,) All information provided by me is true and correct to the best of my knowledge. I understand omissions or misrepresentations may result in rejection of my application or, if employed, may result in subse­quent dismissal. I hereby authorize any former employer, person, school, firm or corporation listed hereon. including this company, to answer any and all questions related to employment and agree to release from liability and hold all persons harmless for giving any and all truthful information within their knowledge or records. I understand this is a preliminary application and not a contract to employ me.

Furthermore, in the event I am employed, my employment shall be completely voluntary and may terminated at will at any time by either myself or the company. I understand that no one other than the company president has authority to enter into any employment agree­ment to the contrary. I agree to take a job related physical examination­ or a drug/alcohol test when requested as a condition of employment. I agree to comply with all rules of the company as a condition of employment. In the event the company advances me money or other things of value, I agree to repay the company and also that any amount still owing maybe deducted from my final paycheck.