Home > Employment-Application HOLLAND MANUFACTURING, CO. EMPLOYMENT APPLICATION Today’s Date First Name MI Last Name Preferred Name / Nickname Street Address City State Zip Code Phone Alternate Phone Email Address PLEASE PLACE A CHECK BY YOUR RESPONSE OR PROVIDE THE APPROPRIATE INFORMATION Are you interested in: Full Time Part Time Temporary What schedules would you prefer? Weekdays Weekends Evenings Nights How did you hear about us? Walk In Referral Advertisement Other Name (Referral): Advertisement – Where: Other (Explain): Have you worked for this company before? No Yes Dates: Do you know anyone who works here? No Yes Name: Desired Pay Hourly Pay (Minimum): Annual Pay (Minimum): Annual Pay (Desired): When are you able to start work? Date: In what local area do you prefer to work? Your Answer: Position desired Your Answer: PLEASE CHECK YES OR NO TO THE FOLLOWING: Are you authorized to work in the United States? YesNo Federal law requires that employers hire only individuals who are authorized to be lawfully employed in the United States… Are you under 18 years of age? YesNo If yes, can you furnish a work permit? YesNo Are you capable of performing the essential functions of the job? YesNo PLEASE LIST YOUR WORK EXPERIENCE BELOW (MOST RECENT JOB FIRST) Massachusetts applicants may include any verified work performed on a volunteer basis. COMPANY NAME YOUR POSITION and TITLE FROM (Month / Year) NO. & STREET SUPERVISOR’S NAME, TITLE and POSITION CITY STATE ZIP CODE SUPERVISOR’S TELEPHONE NUMBER TYPE OF BUSINESS TO (Month / Year) TELEPHONE NUMBER TERMINATION REASON VoluntaryInvoluntary BRIEFLY DESCRIBE YOUR MAJOR DUTIES COMPANY NAME YOUR POSITION and TITLE FROM (Month / Year) NO. & STREET SUPERVISOR’S NAME, TITLE and POSITION CITY STATE ZIP CODE SUPERVISOR’S TELEPHONE NUMBER TYPE OF BUSINESS TO (Month / Year) TELEPHONE NUMBER TERMINATION REASON VoluntaryInvoluntary BRIEFLY DESCRIBE YOUR MAJOR DUTIES COMPANY NAME YOUR POSITION and TITLE FROM (Month / Year) NO. & STREET SUPERVISOR’S NAME, TITLE and POSITION CITY STATE ZIP CODE SUPERVISOR’S TELEPHONE NUMBER TYPE OF BUSINESS TO (Month / Year) TELEPHONE NUMBER TERMINATION REASON VoluntaryInvoluntary BRIEFLY DESCRIBE YOUR MAJOR DUTIES COMPANY NAME YOUR POSITION and TITLE FROM (Month / Year) NO. & STREET SUPERVISOR’S NAME, TITLE and POSITION CITY STATE ZIP CODE SUPERVISOR’S TELEPHONE NUMBER TYPE OF BUSINESS TO (Month / Year) TELEPHONE NUMBER TERMINATION REASON VoluntaryInvoluntary BRIEFLY DESCRIBE YOUR MAJOR DUTIES EDUCATION: NAME AND ADDRESS OF SCHOOL MAJOR SUBJECT DID YOU GRADUATE? TYPE OF DEGREE OR DIPLOMA PROFESSIONAL DESIGNATIONS: DESIGNATION ORGANIZATION GRANTING DATE COMPLETED PROFESSIONAL LICENSES: TYPE OF LICENSE STATE GRANTING LICENSE LICENSE NUMBER REFERENCES: Please list three professional references NAME RELATIONSHIP COMPANY PHONE / ALTERNATE PHONE PLEASE READ CAREFULLY BEFORE SIGNING APPLICATION I have submitted the attached form to the company for the purpose of obtaining employment. I acknowledge that the use of this form, and my filling it out, does not indicate that any positions are open, nor does it obligate the company to further process my application. My signature below attests to the fact that the information that I have provided on my application, resume, given verbally, or provided in any other materials, is true and complete to the best of my knowledge and also constitutes authority to verify any and all information submitted on this application. I understand that any misrepresentation or omission of any fact can be justification for refusal of employment, or termination. I also affirm that I have not signed any kind of restrictive document creating any obligation to any former employer that would restrict my acceptance of employment with the Company in the position I am seeking. I understand that this application is not an employment contract for any specific length of time… References: I hereby authorize the company and its agents to make such investigations… Temporary/Contract Employment: If employed as a temporary or contract employee… Signed: Date: For Massachusetts Applicants Only IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT… For Maryland Applicants Only POLYGRAPH NOTIFICATION AND ACKNOWLEDGMENT: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND… Signature of Applicant: Date: For California Applicants Only (Optional) I am providing my contact information to the Company for limited purposes only… Signature of Applicant: Date: Δ
