Employment Application - Mennie Machine Company, Inc.

MENNIE MACHINE COMPANY IS AN EQUAL OPPORTUNITY EMPLOYER

Equal access to all programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resources Department.

Personal Data

Applicant Information

Date of Application

First Name

Middle Name

Last Name

Home Address

City

State

Zip

Phone

Call/Message Phone

Email

Employment Details

Type of Employment Desired full-time part-time

Position Applied For

Date Available for Work

What is your desireable wage range:

Referred to Mennie Machine by?

What hours are you available to work?

Are you willing to work any shift? Yes No

Are you willing to work overtime if required? Yes No

Can you perform the functions of any job with or without reasonable accommodations? Yes No

Work Experience

Provide the following information of your past three (3) employers, assignments or activities, starting with the most recent.

Company 1

Employed From

Employed Until

Employer Name

Company Address

City, State, Zip

Supervisor's Name & Title

Supervisor's Phone

May we contact for reference? Yes No Later

Starting Job Title

Final Job Title

Summarize the nature of work performed and job responsibilities:

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Reason for Leaving

Company 2

Employed From

Employed Until

Employer Name

Company Address

City, State, Zip

Supervisor's Name & Title

Supervisor's Phone

May we contact for reference? Yes No Later

Starting Job Title

Final Job Title

Summarize the nature of work performed and job responsibilities:

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Reason for Leaving

Company 3

Employed From

Employed Until

Employer Name

Company Address

City, State, Zip

Supervisor's Name & Title

Supervisor's Phone

May we contact for reference? Yes No Later

Starting Job Title

Final Job Title

Summarize the nature of work performed and job responsibilities:

Starting Hourly Rate/Salary

Final Hourly Rate/Salary

Reason for Leaving

SKILLS

Please check the applicable skillsets below, years of experience and an explanation of Where, When and What Type.

Industrial Equipment

Blue Prints Years Experience Explain

Calipers Years Experience Explain

Micrometers Years Experience Explain

Tools Years Experience Explain

References

Use Non Relatives Only

Reference 1

Name

Company

Title

Phone Number

Years Known

Reference 2

Name

Company

Title

Phone Number

Years Known

Reference 3

Name

Company

Title

Phone Number

Years Known

Writing Skills

In the space provided, please write why you feel you would be an asset to this company and what characteristics you possess that differentiate you from other applicants. Please include at least four to five sentences.

Summary

I certify that all information I have provided in order to apply for and secure work with the employer is True, Complete and Correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (I) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

I certify that I have read, and fully understand and accept all terms of the foregoing Applicant Statement.

Date

Applicant Signature

DRUG FREE WORKFORCE POLICY

It is Mennie Machine's policy to achieve a drug-free workforce and to provide a workplace that is free from the illegal manufacture, distribution, abuse, possession, and/or use of drugs or controlled substances. All applicants for employment must take and pass a drug test after receiving an initial offer of employment. Any failure to take the test at scheduled times may disqualify the applicant from employment. All applicants’ rights to confidentiality and privacy shall be protected in accordance with the law.

CONSENT FOR DRUG TESTING

I hereby consent to the urinalysis test and/or other drug screening to determine the presence of drugs or their metabolites in my system. I also consent to the release of these tests and other relevant medical information to Mennie Machine I hereby release and agree to hold Mennie Machine, the collection facility, the testing laboratory and their employees and agents harmless from any liability to me based upon the testing procedure of the reporting of the test results.

Date

Applicant Signature

VOLUNTARY EEO IDENTIFICATION

Various agencies of the United States Government require employers to maintain information on applicants pertaining to -actors such as race, sex, and type of position for which an individual applies. The information requested on this sheet is compliance with certain record keeping requirements. The Company believes all persons are entitled to equal employment opportunities and does not discriminate against it employees or applicants for employment because of race, color, sex, religion, national origin, disability, veteran status, age, marital status or any other protected group status.

Name

Date

Position Applied For

Social Security Number

Date of Birth

Gender Male Female

Regulations issued by the U.S. Department of Labor with respect to disabled individuals, disabled veterans, and Vietnam Era veterans require that federal contractors provide an opportunity for self-identification to candidates seeking employment. Such self-identification is submitted on a voluntary basis, on a confidential basis, for use only in accordance with regulations, and without subjecting the individual to adverse treatment.

Disabled/Veteran Classification(s) Disabled Person Vietnam Era Veteran Special Disabled Veteran (30% or more disability I am not a Disabled/Veteran Person

EXPLANATION OF THE CATEGORIES:

White (Non-Hispanic panic origin): Persons having origins in any of the original peoples of Europe, North Africa or the Middle East

Black (Non-Hispanic): Persons having origins in any of the black racial groups of Africa.

Asian or Pacific Islander: Persons having origins in any of the original peoples of the Far East, Southeast Asia, the Pacific Islands or the Indian subcontinent including. for example, China, Japan, Korea, the Philippines, Samoa, India, and Pakistan

Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South America or other Spanish culture or origin, regardless of race.

American Indian or Alaskan Native: Persons having origins in any of the original peoples of North America and who maintain cultural identification through tribal affiliation or community recognition.

Disabled Individual: Federal regulations define a disabled person as one who (I) has a physical or mental impairment which substantially limits one or more of such person's major life activities, (2) has a history of such impairment, or (3) is regarded as having such an impairment.

Vietnam Era Veteran: Federal regulations define a veteran of the Vietnam Era as one who (1) served on active duty for a period of more Than 180 days, any part of which occurred between August 5, 1964, -and May 7, 1975, and was discharged or released with other than a dishonorable discharge, or (2) was discharged or released from active duty for a service connected disability if any part of such active duty was performed between August 5, 1964, and May 7, 1975.

Special Disabled Veteran: Federal regulations define a special disabled veteran as one who (1) is entitled to compensation under laws administered by the Veterans' Administration for a disability rated 30% or more, or (2) -was discharged or released from active duty because of a service-connected disability.

AN EQUAL OPPORTUNITY EMPLOYER

Thank you for your application to Mennie Machine for employment. Our HR Department will review your information.