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Employment Application

Golden Manufacturing Co., Inc. is an Equal Opportunity/Affirmative Action Employer

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PERSONAL INFORMATION
Name*
First Middle Last
Phone Number*
County:
Address*
Street Address City State ZIP Code
How long there?
Email Address*
Position applying for:
Date available:
MM slash DD slash YYYY
Wages Desired: $
Have you previously worked for Golden Manufacturing Co., Inc.?*
- Yes
- No
When?
MM slash DD slash YYYY
If so, position held:
Do you have relatives employed by Golden Manufacturing Co., Inc.?
- Yes
- No
Name:
Were you referred to Golden Manufacturing Co., Inc.?
- Yes
- No
By whom?
Are you authorized to be employed in the United States? (All offers of employment are contingent upon verification of employment eligibility under the Immigration Reform and Control Act of 1986)*
- Yes
- No
Are you under 18 years of age?*
- Yes
- No
Do You Have a Valid Driver's License?*
- Yes
- No
Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation?*
- Yes
- No
If no, please explain:
EDUCATION/TRAINING
Select last grade completed
Are you currently attending school?
- Yes
- No
If yes, estimated graduation date:
MM slash DD slash YYYY
Name of High School:
Location:
Major Courses Taken:
Diploma Received:
- Yes
- No
Graduate College/University Attended:
Degree Received:
- Yes
- No
Name of Apprentice, Business, Tech., or Vocational School
Location:
Major Field:
Diploma/Certificate Received:
- Yes
- No
List special skills or training
CURRENT AND PREVIOUS EMPLOYMENT
List current and most recent employer first. Include all breaks in employment or periods of unemployment. (Add additional sheet if necessary).
Company Name:*
Address*
Street Address City State ZIP Code
From*
MM slash DD slash YYYY
To*
MM slash DD slash YYYY
Job Title:*
Starting Salary:
Is this your first job?*
- Yes
- No
Company Name:
Address
Street Address City State ZIP Code
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Job Title:
Starting Salary:
Reason for leaving:
Company Name:
Address
Street Address City State ZIP Code
From
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Job Title:
Starting Salary:
Reason for leaving:
Have you ever been fired or asked to resign from any postion?*
- Yes
- No
If yes, please explain:
Do you currently receive pay from any other source? (Do not disclose alimony or child support payments.)
- Yes
- No
If yes, please explain:
MILITARY
Have you served in the U.S. Military, Reserves, or National Guard?
- Yes
- No
Branch of Service
Highest Rank
Were you dishonorably discharged?
- Yes
- No
Indicate any skills or training acquired during military service you feel might of interest or value to Golden Manufacturing Co., Inc.
PERSONAL HISTORY
Have you ever pled no contest to or been convicted of a crime other than a minor traffic violation?*
- Yes
- No
(This information will not necessarily bar an applicant from employment.)
If yes, please explain fully including the date, place, nature of the crime, and the date of your plea or conviction and completion of any sentence. (Add additional sheet if necessary.)
REFERENCES
Name
First Last
Phone Number
Address
Street Address City State ZIP Code
Name
First Last
Phone Number
Address
Street Address City State ZIP Code
Name
First Last
Phone Number
Address
Street Address City State ZIP Code
PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING:
RELEASE, PRIVACY STATEMENT, AND AGREEMENT TO ARBITRATE ALL CLAIMS
I understand that Golden Manufacturing Co., lnc. (the "Company") requires certain information about me to evaluate my qualifications for employment and to conduct its business if! become an-employee. Therefore, I authorize the Company to investigate my past employment, criminal record, credit, educational credentials, and other employment-related activities. I agree to cooperate in such investigations and release all parties from all liability or responsibility with respect to the information supplied. I also agree to submit to any drug or alcohol testing which is required to qualify for employment with the Company.
I understand that this application is not an offer of employment and that by accepting my application, the Company does not guarantee that I will be offered a job. I also understand that if I am offered a job, the Company reserves the right to make such changes in the terms and conditions of my employment as the Company determines to be necessary or appropriate.
I understand that an employment with the Company would be en employment-at-will, meaning my employment would not be for any fixed period of time end that., If employed, I may resign at any time for any reason with or without notice, and the Company may terminate my employment at any time for any reason, with or without notice. I further acknowledge my understanding that statements that may be contained in policies, handbooks, and other Company materials do not create any guarantee of employment nor contractual rights, express or implied, and I agree that I will not rely upon them as such. I also understand and agree that such policies may be changed at any time, with or without notice. I further acknowledge that no supervisor, manager, executive or any employee or agent of the Company has the authority to alter any of the above, and that any promises to the contrary will only be relied upon by me if they are in writing and signed by the Company President and myself.
I certify that all the above information is true and complete in all respects, and that I am submitting this information and any other information during the application process so that the Company can rely on this information in making employment decisions. I understand that any false answers or statements or omissions made by me on this application or any supplement thereto or in connection with the above-mentioned investigations, regardless of when discovered by the Company, will be grounds for immediate disqualification or discharge, if I am employed. I understand, also, that I am required to abide by all rules and regulations of the Company. I further understand that any offer of employment may be contingent upon successfully completing a medical evaluation indicating that I am able to perform the essential functions of the job, with or without reasonable accommodations.
I further understand that any offer of employment may be contingent upon successfully completing a medical evaluation indicating that I am able to perform the essential functions of the job, with or without reasonable accommodations.
ln consideration of the Company's agreeing to accept my application for consideration, I acknowledge and agree that any controversy or claim that I may have as an applicant or arising from my later employment, if hired, shall be submitted to binding arbitration before a single arbitrator with the arbitration to be conducted pursuant to the provisions of the National Rules for Resolution of Employment Disputes of the American Arbitration Association then in effect ("Arbitration Rules"). If subsequently hired by the Company, I agree to abide by the Company's Employment Arbitration Policy. I agree (i) my application for employment; (ii) my employment, if I am subsequently hired by the Company, and (iii) the business of the Company affects or has a direct impact upon "interstate commerce," as defined in the Federal Arbitration Act, and that this provision is enforceable thereunder. All costs and expenses of arbitration, including compensation expenses of the arbitrator, shall be borne by the parties as set forth in the Arbitration Rules.
I acknowledge that I have read, understand, and agree to abide by the terms of the above RELEASE AND PRIVACY STATMENT.
Today's Date*
MM slash DD slash YYYY
Name (Please Print)*
First Last
Signature*
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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High School Graduate
13 (Technical/Vocational School)
14 (Technical/Vocational School)
15 (College Freshman)
16 (College Sophomore)
17 (College Junior)
18 (Bachelor Degree)
19 (Master Degree)
20 (Ph.D.)

Employment Application

PERSONAL INFORMATION

EDUCATION/TRAINING

CURRENT AND PREVIOUS EMPLOYMENT

MILITARY

PERSONAL HISTORY

REFERENCES

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING: