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Application For Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Required Fields are in marked with a red * asterisk

Inside Sales Representative - Mentor, Ohio


How Did You Learn About Us?	Advertisement	Relative	Inquiry	Friend
	Employment Agency	Internet	Other


First Name: *			Middle Name:
Last Name: *
Address1: *			Address 2:
City: *			State: *
Zip: *
Home Phone #: *			Cell Phone #:
Social Security #:

Emergency Contact:			Relationship:
Address:			Phone #:


The Best time to reach you at home is: * am pm

If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes No

Have you ever filed an application with us before? Yes No If Yes, give date.

Have you ever been employed with us before? Yes No If Yes, give date.

Do any of your friends or relatives work here? Yes No If Yes, whom.

Are you currently employed? Yes No

May we contact your present employer? Yes No

Do you have a Non-Compete and/or Confidentiality Agreement with any previous employer? Yes No If Yes, describe in full.

Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses? Yes No If Yes, describe in full.

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? Yes No Proof of citizenship or immigration status will be required upon employment

Date available for work:

What is your desired salary range?

Are you available to work: (Please Indicate)	Full-Time 1st Shift 2nd Shift 3rd Shift
	Part-Time Mornings Afternoons Evenings
	Teporary (Please Indicate dates available) to

Are you currently on “lay-off” status and subject to recall? Yes No

Can you travel if a job requires it? Yes No

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Education

	Name and Address of School	Course of Study	No. of Years Completed	Did You Graduate?	Diploma Degree
Elementary School
High School
Undergraduate College
Graduate College
Other (Specify)

Describe any specialized training, apprenticeship, skills, and extra-curricular activities.

Describe any job-related training received in the United States military.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, age, disabilities, marital or veteran status, or any oher protected status.

Please list your three most recent employers

Employer
Address
Telephone Number
Job Title
Supervisor

Dates Employed
From:	To:


Hourly Rate/Salary
Starting:	Final:

Work Performed

Employer
Address
Telephone Number
Job Title
Supervisor

Dates Employed
From:	To:


Hourly Rate/Salary
Starting:	Final:

Work Performed

Employer
Address
Telephone Number
Job Title
Supervisor

Dates Employed
From:	To:


Hourly Rate/Salary
Starting:	Final:

Work Performed

Work References

1.	Name	Address
	Telephone Number

2.	Name	Address
	Telephone Number

3.	Name	Address
	Telephone Number

Additional Information

List professional, trade, business or civic activities and offices held. You may exclude organizations which indicate race, color, religion, creed, gender, national origin, age, disabilities, marital or veteran status, or any other protected status.


Other Qualifications - Summarize special job-related skills and qualifications acquired from employment or other experience.


Specialized Skills - Check skills/equipment operated.
PC/MAC	Spreadsheet	Terminal
Word Processing	Typewriter - WPM:	Shorthand - WPM:

Production/Mobile Machinery (list)

Other (lists)

State any additional information you feel may be helpful to us in considering your application.

Applicant's Statement

NOTE TO APPLICANTS: DO NOT answer this question unless you have read the job description and/or been informed about the requirements of the job for which you are applying.

A review of the activities involved in the job or occupation for which you have applied has been given.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? Yes No


I certify that answers given herein are true and complete. I understand that employment with this organization is conditional on successful passage of a pre-employment drug screen. Should I fail the pre-employment drug screen for any reason I am responsible for the cost of said drug screen. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an“at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I agree that any claims or lawsuits relating to my service with the Company or any of its affiliates or subsidiaries must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules, regulations, policies, and procedures of the Employer.


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