Employment

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Date
MM slash DD slash YYYY
Name*
First Name Middle Last Name Preferred Name/Nickname
Street Address City State / Province / Region ZIP / Postal Code
Email*
Phone*

Business Experience and References
Interested In
- Full Time
- Part Time
Preferred Schedule*
- Weekdays
- Weekends
- Evenings
- Nights
How did you hear about the position?*
- Classified Ad
- Internet
- Friend (Name)
Friend Name
Friend Name
Desired Pay:
Hourly Pay
Annual Pay
Minimum Desired
When are you able to start work?
Date
MM slash DD slash YYYY
Position Desired*

PLEASE CHECK YES OR NO TO THE FOLLOWING:
Are you authorized to work in the United States?*
- Yes
- No
Federal law requires that employers hire only individuals who are authorized to be lawfully employed in the United States. In compliance with these laws, Queen City Steel Treating will verify the status of every individual offered employment with the Company. In this connection, all offers of employment are subject to verification of the applicant’s identity and employment authorization, and it will be necessary for you to submit such documents as are required by law to verify your identification and employment authorization.
Are you under 18 years old?*
- Yes
- No
If yes, can you furnish a work permit?
- Yes
- No
Are you capable of performing the essential functions of the job for which you are applying with or without a reasonable accommodation?*
- Yes
- No

PLEASE LIST YOUR WORK EXPERIENCE BELOW (MOST RECENT JOB FIRST)
*
Company Name Your Position and Title
Supervisors Name,Title And Position Supervisor Telephone Number
From (Date)
MM slash DD slash YYYY
No & Street City State Zip Code
Type of Business
To (Date)
MM slash DD slash YYYY
Telephone Number
Termination
- Voluntary
- Involuntary
Reason
Briefly describe your major duties and reason for termination

Education:
Name of Institution*
City and State of School*
Did You Graduate?*
- Yes
- No
Years Attended?*
Degree Received?
- Yes
- No

Professional Designations
Designation Organization Granting Designation
Date Completed
MM slash DD slash YYYY
Professional Licenses:
Type of License State Granting License License Number

References: please list three professional references
Name Relationship Company Phone/Alternate Phone
References: please list three professional references
Name Relationship Company Phone/Alternate Phone
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 in my application, resume or any other materials, or during any interviews, can be justification for refusal of employment, or, if employed, termination from the Company’s employ. 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 between the Company and me, and that in the event I am hired, my employment will be “at will” and either the Company or I can terminate my employment with or without cause and with or without notice at any time. Nothing contained in any handbook, manual, policy and the like, distributed by the Company to its employees is intended to or can create an employment contract, an offer of employment or any obligation on the Company’s part. The Company may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy practice, condition or process affecting its employees.
References: I hereby authorize the company and its agents to make such investigations and inquiries into my employment and educational history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, and other persons from all liability in responding to inquires connected with my application and I specifically authorize the release of information by any schools, businesses, individuals, services or other entities listed by me in this form. Furthermore, I authorize the company and its agents to release any reference information to clients who request such information for purposes of evaluating my credentials and qualifications.
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