Employment Application Form

We are an Equal Opportunity Employer.

You must complete entire application and submit when completed.

Gornell Brush Application Information

First Name *

Middle Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State *

ZIP Code *

Email Address *

Cell Phone *

Home Phone

Are there other names under which you have worked or attended school? *YesNo

If yes, please list for reference checking purposes.

Are you legally authorized to work in the U.S.? *YesNo

Have you ever been convicted of a crime or pleaded no contest for any offense or violation other than minor traffic violations? *YesNo

If Yes, explain 1) nature of crime, 2) date of conviction, and 3) state in which convicted. (Convictions are not an automatic bar to employment.)

Do you have any pending criminal charges against you? *YesNo

If Yes, describe the 1) nature of the charges, 2) date issued, and 3) county and state where issued.

Position Information

Enter the name of the position you are applying for: *

Part-Time or Full-Time Desired *Full TimePart Time

Salary Preference *

Shift Preference *

When can you start? *

1. If relevant, please describe computer proficiency, software knowledge, and office equipment experience.

2. If relevant, please describe experience using manufacturing machines and equipment.

Education

Level of Education

High SchoolCollegeGraduate SchoolOtherCheck all that apply, then fill in the information completely for each section.

HIGH SCHOOL

Name & Location (city, state) *

Number of Years Attended *

Major Subjects *

Diploma or Degree Received *YesNo

COLLEGE

Name & Location (city, state)

Number of Years Attended

Major Subjects

Degree(s) Received *YesNo

Type(s)

Add a CollegeYesNo

Name & Location (city, state)

Number of Years Attended

Major Subjects

Degree(s) Received *YesNo

Type(s)

GRADUATE SCHOOL

Name & Location (city, state) *

Number of Years Attended

Major Subjects

Degree(s) Received *YesNo

Type(s)

OTHER

Name & Location (city, state) *

Number of Years Attended

Major Subjects

Diploma or Degree(s) Received *YesNo

Type(s)

Training Courses

Add a Course / SeminarYesNo

Course/Seminar

Organization Sponsoring

Content

Dates Attended

Add a Course / SeminarYesNo

Course/Seminar

Organization Sponsoring

Content

Dates Attended

Add a Course / SeminarYesNo

Course/Seminar

Organization Sponsoring

Content

Dates Attended

Add a Course / SeminarYesNo

Course/Seminar

Organization Sponsoring

Content

Dates Attended

Required License(s)

Does the job require you to drive a motor vehicle? *YesNo

Driver's License Number

State Issued

Are you licensed with any group, association or society relating to the job for which you are applying? *YesNo

Registration or License Number

State Issued

Expiration Date

Employment History (start with most recent)

Name of Employer *

Phone *

Street Address *

Suite, etc

City *

State *

ZIP *

Country

Job Title *

Name of Immediate Supervisor *

Description of Duties *

Start Date *

End Date *

Starting Salary *

Ending Salary *

Reason for Leaving *

If currently employed, may we contact as a reference? *YesNo

Add an EmployerYesNo

Name of Employer

Phone

Street Address

Suite, etc

City

State

ZIP

Country

Job Title

Name of Immediate Supervisor

Description of Duties

Start Date

End Date

Starting Salary

Ending Salary

Reason for Leaving

Add an EmployerYesNo

Name of Employer

Phone

Street Address

Suite, etc

City

State

ZIP

Country

Job Title

Name of Immediate Supervisor

Description of Duties

Start Date

End Date

Starting Salary

Ending Salary

Reason for Leaving

Add an EmployerYesNo

Name of Employer

Phone

Street Address

Suite, etc

City

State

ZIP

Country

Job Title

Name of Immediate Supervisor

Description of Duties

Start Date

End Date

Starting Salary

Ending Salary

Reason for Leaving

Employment References

Please provide three references.

List individuals familiar with your job qualifications (no relatives or personal friends).

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State *

ZIP *

Country

Phone *

Email Address *

Relationship *

How long known? *

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State *

ZIP *

Country

Phone *

Email Address *

Relationship *

How long known? *

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State *

ZIP *

Country

Phone *

Email Address *

Relationship *

How long known? *

BY SUBMITTING THIS APPLICATION FORM, I ACKNOWLEDGE THE FOLLOWING:

All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired.
I authorize the company to investigate my responses on this application and contact any or all of my former employers or any individuals familiar with my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information about my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining to me or my employment.
I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified.)
Regardless of whether or not I become employed by the company, I recognize this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the company’s, unless specifically provided otherwise in a written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than an officer or official of the company, and then only by means of a signed, written document.

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Employment Application Form

Gornell Brush Application Information

Position Information

Education

Level of Education

Training Courses

Required License(s)

Employment History (start with most recent)

Employment References

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