Employment Application

Instructions: Please read carefully. Every item on this form must be answered to the best of your ability. Incomplete applications may not be considered. Some positions require testing. Until this testing is completed, your application will be considered incomplete. Your qualifications will be carefully reviewed and you will be given consideration for any suitable opening. Upon employment, this application will become a part of your permanent record with our company. Keep this in mind as you complete it. Special Note: You are not required to supply any information which is prohibited by Federal, State, or Local laws. We are an Equal Opportunity Employer.

Section I: General Information Name: Date: Address: City, State, Zip: Previous Address: Previous Address City, State, Zip: Phone: Other Phone: Are you legally entitled to work in the USA?  Yes  No Have you ever been convicted of a felony? Yes   No If Yes, give details: Position or type of work desired: Click to Select Employment Position Requested Brush Production/Plastic Extrusion - Machine Operator Brush Production/Plastic Extrusion - Fabricator Operator Brush Production/Plastic Extrusion - Extrusion Fabricator Brush Production/Plastic Extrusion - Set-Up/Operator Brush Production/Plastic Extrusion - Extrusion Technician Maintenance - Machine Maintenance (Machine Mechanics) Warehouse - Shipping and Receiving Warehouse - Material Handling Other: List here all equipment with which you have training and/or experience. Give detailed information on the length of time of the training or experience: Availability: (check all that apply) Full-Time Part-Time Seasonal 1st Shift 2nd Shift 3rd Shift Overtime Weekends Holidays Temporary   List preferences or limitations (if applicable): Salary or wage expected: Are you willing to relocate? Yes  No Have you worked for us before?  Yes  No If so, when? List anyone you know who is currently in our employ: Section II: Education High School Name: Address, City, State, Zip: Did you graduate?  Yes  No If not, last grade completed: GED?  Yes  No GPA: Course of Study: College/Vocational School Name: Address, City, State, Zip: Did you graduate?  Yes  No If not, hours completed: Do you plan on returning?  Yes   No GPA: Degree or Course of Study: College/Vocational School Name: Address, City, State, Zip: Did you graduate?  Yes  No If not, hours completed: Do you plan on returning?  Yes   No GPA: Degree or Course of Study: Other Education: (give names of institutes and dates, if applicable) Section III: Employment History List employment beginning with your current or most recent employer first: Employer Name: Employer Address: Kind of Business: Your Position: Starting Wage: Ending Wage: Starting Date: Ending Date: Reason for leaving or wanting to leave: Quit Discharge Lay Off Please select:                               Other: Reference Information: Name: Phone (2) Employer Name: Employer Address: Kind of Business: Your Position: Starting Wage: Ending Wage: Starting Date: Ending Date: Reason for leaving or wanting to leave: Quit Discharge Lay Off Please select:                               Other: Reference Information: Name: Phone (3) Employer Name: Employer Address: Kind of Business: Your Position: Starting Wage: Ending Wage: Starting Date: Ending Date: Reason for leaving or wanting to leave: Quit Discharge Lay Off Please select:                               Other: Reference Information: Name: Phone List any employer you do not want us to contact and why not: List and briefly describe any other employment you have had that you could not list above: Company: Dates Worked: Position/Duties: Company: Dates Worked: Position/Duties: Company: Dates Worked: Position/Duties: Explain any time gaps in your employment: List below any service in the U.S. Armed Forces: Branch: Service Dates: Rank at Discharge: Military Experience that may be applicable: Section IV: Conditions of Employment Please read carefully. Submission of this application acknowledges the following: The facts as stated on this application are true and correct. I understand that, if employed, false statements on this application may cause my immediate discharge. I understand that I may be required to work overtime as a condition of being employed here. In consideration of my employment, I agree to conform to the rules and regulations for employees. I understand that my employment and compensation can be terminated, with or without cause, at any time, at the option of either the company or me. I understand that no representative of the company can enter into any agreement for employment for any specified period of time or to make any agreement contrary to the foregoing. I understand that I may be required to submit a pre-employment and post-employment test for fitness, honesty, arrest and conviction records, and/or substance abuse, if not prohibited by law. Upon separation of employment, I authorize The Malish Corporation to withhold from my final pay check any moneys owed to them by me.