Employment Application PERSONAL INFORMATIONYou can upload a resume here (optional)Max. file size: 64 MB.Name(Required) First Last Today's Date(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State ZIP / Postal Code Phone(Required)Email Are you legally eligible to work in the United States?(Required) Yes No EMPLOYMENT DESIREDPosition(s) Applied For:(Required) Add RemoveDate Available MM slash DD slash YYYY Desired SalaryWhat Shift? First Shift Second Shift Either How did you hear about Dudek & Bock? If you were referred by a Dudek & Bock employee, please list name: Have you been employed by Dudek & Bock before? List date & position: EMPLOYMENT HISTORYCompany Name ( 1 ) Company TelephoneAddress Dates of Employment Starting Job Title Ending Job Title Immediate Supervisor Pay rate ($ per ____ ) Reason for Leaving May we contact for reference? Company Name ( 2 ) Company TelephoneAddress Dates of Employment Starting Job Title Ending Job Title Immediate Supervisor Pay rate ($ per ____ ) Reason for Leaving May we contact for reference? EDUCATIONHigh School Name Dates Attended City/State Grade Completed College/University Dates Attended City/State Degree Graduate School Dates Attended City/State Degree Trade School or Other Training Dates Attended City/State Degree APPLICANT STATEMENTI certify that the information I have provided is true, correct, and complete. False, incomplete, or misrepresented information of any kind will be sufficient cause for my application to be rejected, or if discovered after employment, cause for immediate termination. I authorize Dudek & Bock Spring Manufacturing Company, its representatives, employees, or agents to contact and obtain information about me from previous employers, educational institutions, public agencies, and licensing authorities to otherwise verify the accuracy of all information provided by me in the application, resume, or interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering, and using truthful and non-defamatory information in a lawful manner in the employment process, and regarding all other persons, corporations, or organizations that provide information for this purpose. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability or any other protected status under applicable federal, state or local law. The Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability or any other protected status. I understand that this application remains current for only 30 days. After 30 days, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application. If I am hired, I understand that I am free to resign at any time, with or without cause, and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause, and with or without notice, except as may be required by law. This application does not constitute an agreement or contract of employment for any specified period or definite duration. I understand that no one, other than the employer's president, has authority to enter into any employment agreement with terms contrary to the foregoing unless in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.(Required) I certify that I have read, fully understand, and accept all terms and conditions.I certify that the information I have provided is true, correct, and complete. False, incomplete, or misrepresented information of any kind will be sufficient cause for my application to be rejected, or if discovered after employment, cause for immediate termination. I authorize Dudek & Bock Spring Manufacturing Company, its representatives, employees, or agents to contact and obtain information about me from previous employers, educational institutions, public agencies, and licensing authorities to otherwise verify the accuracy of all information provided by me in the application, resume, or interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering, and using truthful and non-defamatory information in a lawful manner in the employment process, and regarding all other persons, corporations, or organizations that provide information for this purpose. I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, genetic information, citizenship, age, disability or any other protected status under applicable federal, state or local law. The Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability or any other protected status. I understand that this application remains current for only 30 days. After 30 days, unless otherwise notified, I understand that my status as an applicant will end. I may re-apply for employment in the future by completing a new application. If I am hired, I understand that I am free to resign at any time, with or without cause, and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause, and with or without notice, except as may be required by law. This application does not constitute an agreement or contract of employment for any specified period or definite duration. I understand that no one, other than the employer's president, has authority to enter into any employment agreement with terms contrary to the foregoing unless in writing and signed by the employer's president. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. PhoneThis field is for validation purposes and should be left unchanged.
