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APPLICANT INFORMATION

Date:

Name:

First

Middle

Last

Address:

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Address Line 2

City

State

Zip Code

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Phone:

Email:

Date Available:

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Position Applied For:

Desired Salary:

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EDUCATION

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High School:

College:

Other:

Major & Degree:

Years Completed:

MILITARY SERVICE

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Branch:

Start Date:

End Date:

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Rank at Discharge:

Type of Discharge:

If other than Honorable, explain:

Please list all employment starting with the present or most recent employer. Account for all periods, including unemployment. Also, include relevant voluntary and/or part-time work.

PREVIOUS EMPLOYMENT

PREVIOUS EMPLOYMENT 1

Company Name:

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

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Supervisor:

Supervisor Email:

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Job Title:

Start Date:

End Date:

Responsibilities:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

PREVIOUS EMPLOYMENT 2

Company Name:

Phone:

Address:

Address Line 1

Address Line 2

City

State

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Supervisor:

Supervisor Email:

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Job Title:

Start Date:

End Date:

Responsibilities:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

PREVIOUS EMPLOYMENT 3

Company Name:

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

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Supervisor:

Supervisor Email:

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Job Title:

Start Date:

End Date:

Responsibilities:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

PREVIOUS EMPLOYMENT 4

Company Name:

Phone:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

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Supervisor:

Supervisor Email:

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Job Title:

Start Date:

End Date:

Responsibilities:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

List additional training, courses, and other qualifications you have related to the position you are applying for:

APPLICANT: Federal and State Laws require that all applicants be considered without regard to race, religion, color, sex, age, national origin or disability. Application will remain active for 60 days. If hired, you must furnish proof you are eligible to work in the U.S.

APPLICATION TO RELEASE INFORMATION

RELEASE: I hereby authorize the release of information regarding my employment. I further release all persons, employers and Commercial Plastics Kenosha LLC from any and all liability of whatsoever resulting from the furnishing of such information.

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Signature (Type Full Name):

Date:

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 and also authorize any person, school, current employer (except as previously noted), past employers, and organizations named in this application 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 will be required to successfully pass a drug screening examination. I hereby consent to pre and/or post-employment drug screens as a condition of employment, if required.

,I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. 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 CAUSE AND WITH OR WITHOUT NOTICE.

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

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Signature (Type Full Name):

This application for employment will remain active for 60 days.

Date:

Field #152 (copy)

Equal Employment Opportunity Information

As an applicant for employment with Commercial Plastics Kenosha LLC, you are asked to provide the following information to assist us in accumulation of data for the Equal Employment Opportunity Commission. You are not required to provide this information but will help if you do so. This information will be used strictly for statistical record keeping purposes and will not affect your application or our hiring decision. Thank you for your cooperation.

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Date / Time

Position Applied For:

Race/Ethnic Group (please check one):

White (not of Hispanic or Latino Origin)
Black or African-American (not of Hispanic or Latino Origin)
American Indian or Alaskan Native (not of Hispanic or Latino Origin)
Hispanic or Latino
Asian (not of Hispanic or Latino Origin)
Native Hawaiian or Other Pacific Islander (not of Hispanic or Latino Origin)
Two or More Races (not of Hispanic or Latino Origin)

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SPECIAL EMPLOYMENT NOTICE TO VETERANS WITH DISABILITIES, VIETNAM-ERA VETERANS, AND INDIVIDUALS WITH PHYSICAL OR MENTAL DISABILITIES

Government contractors are subject to the Vietnam Era Veterans Readjustment Act of 1974, which requires that they take affirmative action to employ and advance in employment disabled veterans of the Vietnam Era, Section 503 of the Rehabilitation Act of 1973, as amended, which required government contractors to take affirmation action and advance in employment qualified individuals with disabilities, and the Americans with Disabilities Act of 1991.

If you are a veteran with a disability, a Vietnam Era veteran, or have a physical or mental disability, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodations to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration of employment.

Please check one:

Individual with a Disability
Veteran with a Disability
Vietnam Era Veteran

If you wish to be identified as an individual/veteran with a disability or a Vietnam Era Veteran sign here:

Sign Here (Type Full Name)