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Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the company management.

* required

* First Name
* Last Name
* Email Address
* Phone Number
* Address
* City
* State
* ZIP
* Date ( M/D/Y )
* Position: Machine Operator:
Office Clerical:
Supervision:
Other:
* What is your shift preference?
1st 2nd 3rd 4th
* Have you ever been employed here before? If Yes, give dates and positions.
* Date you are available for work. ( M/D/Y )
* What is your desired salary range?
* Are you able to meet the attendance requirements of the position? Yes     No
* If applying for a Machine Operator position, can you read a micrometer? Yes     No
* If you are under 18, can furnish a work permit? Yes     No
* Are you legally eligible for employment in this country? Yes     No
* Have you ever pled “guilty” to or “no contest” to, or been convicted of a crime? Yes     No
If Yes, please provide dates and details
Answering “Yes” to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation rehabilitation and position applied for will be taken into consideration.
* Driver’s license # if driving is an essential job function     State:

Employment History

Provide the following information starting with the most recent
From:
To:
Employer:
Telephone:
Job Title:
Address:
Immediate Supervisor:
Nature of the work performed:
May we contact for a reference? Yes:     No:     Later:
Reason for leaving:
Hourly Rate / Salary: Starting:   per  
  Final:        per  


From:
To:
Employer:
Telephone:
Job Title:
Address:
Immediate Supervisor:
Nature of the work performed:
May we contact for a reference? Yes:     No:     Later:
Reason for leaving:
Hourly Rate / Salary: Starting:   per  
  Final:        per  


From:
To:
Employer:
Telephone:
Job Title:
Address:
Immediate Supervisor:
Nature of the work performed:
May we contact for a reference? Yes:     No:     Later:
Reason for leaving:
Hourly Rate / Salary: Starting:   per  
  Final:        per  

Educational Background

Provide the following information starting with the most recent
 

High School:

   Name of School
 
Years Completed
 Graduate?
 Course of Study
 

College:

  Name of School
 
Years Completed
 Graduate?
 Course of Study
 

Other:

  Name of School
 
Years Completed
 Graduate?
 Course of Study

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with Hydra-Seal, Inc. is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application, or immediately discharge me from service with Hydra-Seal, Inc. , whenever it is discovered.

I expressly authorize, without reservation, Hydra-Seal, Inc. , its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job 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 such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that Hydra-Seal, Inc. does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from Hydra-Seal, Inc. and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am offered a position, I submit to a comprehensive post offer physical, musculoskeletal assessment and a drug screening provided by a clinic of Hydra Seal’s choice.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and Hydra-Seal, Inc. reserves the right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of Hydra-Seal, Inc. is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the president of Hydra-Seal, Inc. .

I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and federal immigration laws require me to complete an I-9 Form in this regard.

I also give Hydra-Seal, Inc. authorization to make payroll deductions for lost uniform garments if I am a participant of that program and for articles I purchase through the company.

Do not sign until you have read the above Applicant Statement.

I certify that I read, fully understand and accept all terms of the foregoing Applicant Statement.


* Signature of Applicant


* Date
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