Please fill out this form as completely as possible. If you would prefer to print an application you may do so here. Position Applied For Position Title Years of experience in this field Personal Information First Name Last Name Middle Initial Home Phone # Cell Phone # Work Phone # Email Address Name of someone who knows how to contact you if your address changes Contact's Phone # Contact's (relationship to you) How did you find out about this job opening? Web Page (identify)Newspaper/Journal Ad(identify)ReferralJob Service/Michigan WorksOther(Please Explain) Explain: Are you authorized to work in the U.S.? YesNo If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986. Are you in anyway related to an Employee of Northwoods Mfg? YesNo If yes, indicate the individual's name, relationship and department. Person's Name Person's Relation Person's Department Minimum Acceptable Hourly Wage? Date available for employment? Education - List most recent first Name of Trade, Tech School, or College Advisor Date Attended From Date Attended To Type of Degree Permits/Licenses Year Professional & Community Involvement - List most relevant Name of Organization Position or Type of Activity Duration of Involvement From Duration of Involvement To Awards/Recognition Received Reason for Ending Involvement Employment History - List all employment including military and volunteer service starting with the most current position held. Show employment history for at least 10 years or from the time you left school. Explain gaps in employment history. You may attach a resume, but you must complete the emplyment section. This information will be used in reference checks. Failure to answer all items in the following section may eliminate you from further consideration. Dates Employed(Month/Year)From : Dates Employed(Month/Year)To : Position Title Hourly Starting Wage Final Hourly Wage Organization Name/Address Full-timePart-time hrs/wk if part time May we contact for references? YesNo Supervisor's Name/title Supervisor's Phone Number Reason For Leaving Duties Dates Employed(Month/Year)From : Dates Employed(Month/Year)To : Position Title Hourly Starting Wage Final Hourly Wage Organization Name/Address Full-timePart-time hrs/wk if part time May we contact for references? YesNo Supervisor's Name/title Supervisor's Phone Number Reason For Leaving Duties Dates Employed(Month/Year)From : Dates Employed(Month/Year)To : Position Title Hourly Starting Wage Final Hourly Wage Organization Name/Address Full-timePart-time hrs/wk if part time May we contact for references? YesNo Supervisor's Name/title Supervisor's Phone Number Reason For Leaving Duties Dates Employed(Month/Year)From : Dates Employed(Month/Year)To : Position Title Hourly Starting Wage Final Hourly Wage Organization Name/Address Full-timePart-time hrs/wk if part time May we contact for references? YesNo Supervisor's Name/title Supervisor's Phone Number Reason For Leaving Duties Dates Employed(Month/Year)From : Dates Employed(Month/Year)To : Position Title Hourly Starting Wage Final Hourly Wage Organization Name/Address Full-timePart-time hrs/wk if part time May we contact for references? YesNo Supervisor's Name/title Supervisor's Phone Number Reason For Leaving Duties References - At minimum, list current supervisor and.or academic Advisor and two professional/academic references. In addition to work references indicated in the employment history section, the following references may be contacted. Name Type of reference Occupation Street and city address, Zip Phone Cell Email In the box bellow, please briefly list other information about your professional background and career goals which could be pertinent to an employment decision. Personal Qualities - List a few things about yourself that you feel make you the type of person we are looking for. Abilities - In some lines of work you may be asked to lift up to 50lbs a few times a day or 30lbs 50 times a day you may be expected to bend, climb, or be on your feet all day. Are you physically able to perform the job you are applying for and what do you belive you will physically be doing? If you were employed with this company are you able to work, fill in all that apply. overtime as needed with notice a day in advanceas needed no noticeSaturday twice a monthSaturday as neededNo SaturdayVery little overtime Explain Transportation - Check all that apply. Have a vehicle and driveLive close to work and walkWill find a rideHave a way to work Please Read Carefully and Sign By checking this box I certify that the above statements are correct. I understand that any false information (or omissions) in this application, or its supporting documents, will be sufficient grounds for refusal to hire me or termination without notice. I agree that all rules, orders and regulations affecting my employment shall constitute a part of my appointment or employment. I Agree Date: Notice Of Non-discrimination - Per Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973, Northwoods Mfg. does not discriminate on the basis of race, color, religion, national origin, ancestry, sex, age, disability, sexual orientation or status as disabled veteran or veteran of the Vietnam Era. Please Read Carefully and Sign At will Relationship I am aware that if I am offered a position with this company, I will be employed at will and my employment may be terminated by me or the company at any time, With or without cause or notice. I understand no person other then the company President or Vice President has the authority to enter into any agreement for employment for any special period of time or to make any agreement signed by both myself and the president. Release of records The company may obtain a consumer report in connection with your application for employment or at any time during your employment this report may include information about your education, employment history, criminal record, credit history, and driving record among other things. Your signature below authorizes the company to obtain such a report. Under the fair Credit Reporting Act you are entitled to a copy of such report, should the company take adverse action against you based on the report. I understand fully that I must pass a required pre-employment drug screening. I understand that Northwoods holds the right to terminate the employee/employer relationship based on the results of these tests. I understand that I will be responsible for any cost that may be accumulated by these tests if I fail any of the tests. I understand that the standards of the tests are set by the Dickinson Occupational Clinic and do not reflect Northwoods Mfg. in anyway. I Agree Date: Resume Upload:
