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First Name*
Last Name*
Street*
City*
State* ZIP Code*
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Note: Your e-mail address and all other personal information will not be shared with any party. All information is kept strictly confidential.
Position Applied For*
(Please Record Job # if Applicable)  


Requested Salary
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Skills

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Resume
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Employment History (List most recent employer first)
Name of employer:
 Address:
 Phone:
Start Date:
 End Date:
 Start Salary:
 End Salary:
 May we contact for reference?
Your Title:
 Name & Title of Supervisor:
 Reason for Leaving:
Describe your duties:
Name of employer:
 Address:
 Phone:
Start Date:
 End Date:
 Start Salary:
 End Salary:
 May we contact for reference?
Your Title:
 Name & Title of Supervisor:
 Reason for Leaving:
Describe your duties:
Name of employer:
 Address:
 Phone:
Start Date:
 End Date:
 Start Salary:
 End Salary:
 May we contact for reference?
Your Title:
 Name & Title of Supervisor:
 Reason for Leaving:
Describe your duties:
Education
Type of
School 		Name of School Courses Majored In Last Year
Completed		 Degrees Recv'd Last Year
Attended
High School
College
College
Business or
Trade School
Other

Military Service Record
Are you a Veteran? Dates of active Service: Branch of Service: Highest Rank or Grade:
From: To:
Principal Duties: Current Draft Classification:

Criminal Record
Have you ever been convicted of a crime?
Have you ever pleaded guilty or nolo contendere to a criminal charge?
If yes, when? What charge?
*A "Yes" answer will not be an automatic bar from employment. Revelant factors will be considered.

Health And Physical Condition
Do you have any physical or mental disability which would preclude you from performing the job you applied for?
If yes, describe such disability, specific work limitations and/or any accommodations needed.
Disability:
Job Limitations:
Accommodations:
 
APPLICANT DATA RECORD
Qualified applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap.

As employer/government contractors, we comply with government regulations and affirmative action responsibilities.

Solely, to help us comply with government record keeping, reporting and other legal requirements please complete this Data Record.

This data is for periodic government reporting and will be kept in a confidential file separate from the Application for Employment.
Referral Source Internet Ad Newspaper Ad
Friend Relative Employment Agency
Other
 
Affirmative Action Survey
Government agencies require periodic reports on the sex, ethnicity, handicapped and veteran status of applicants. This data is for analysis and affirmative action only. Submission of information about a handicap is voluntary.
Check one:* Male Female
Check one of the following race/ethnic Group:* White
Black/African American
Hispanic/Latino
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Asian
Two or More Races
 
Check if any of the following are applicable: Vietnam Era Veteran
Disabled Veteran
Handicapped Individual
Other Protected Veteran
Newly Separated Veteran
   
I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered sufficient cause of dismissal. The Company is hereby authorized to make any investigation of my past work or personal history. I release any and all sources from all liability on the issuance of any such information.

I understand that if I am employed by Sunnen Products Company that my employment and compensation can be terminated, with or without cause and with or without notice at any time, at the option of either the Company or myself. I also understand that neither this Application For Employment nor any present or future employee handbook or personnel policy manual is an employment agreement, either expressed or implied and that no employee or manager of Sunnen Products Company except the Manager, Human Resources, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I understand that any binding agreement must be in writing and signed by both the Manager, Human Resources, and myself.
   
 


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