Thermold Corporation

Are you 18 years or older?
Yes No

Have you ever worked or attended school under another name? If so, under what name?:

Are you either a citizen or authorized to
work in the U.S.?
Yes No

Have you ever been convicted of a crime?**
Yes No

If yes, give details, including date(s):

** A “yes” answer will not automatically disqualify you from employment. We will consider the nature and date of the offense and the job for which you are applying for job-related purposes only, and only to the extent permitted by applicable law.

Position Desired

Position: Date you can start: Pay rate desired:

Do you prefer:
Full-time Part-time

Hours per week desired:

Hours you are available to work:

How did you learn about this opening?

Have you previously worked for this company? If so:

From:

To:

Reason for leaving: Former supervisor(s) at this company:

Are you available to work overtime?
Yes No

Are you able to work:

Weekends*
Holidays*
Nights*

* if required for the position for which you’re applying

Education

Are you familiar with personal computers?
Yes No

PC MAC

Can you type?
Yes No WPM:

What computer programs are you familiar with?

Other education or training:

Military Experience

Branch of Service: Rank at Discharge:

Dates Served: Education and Training:

Work Experience

Work Experience 1

Employer: Address: Position Held:

From:

To:

Description of Duties:

Start Wage:

Final Wage:

Reason for Leaving:

May we contact?
Yes No

Work Experience 2

Employer: Address: Position Held:

From:

To:

Description of Duties:

Start Wage:

Final Wage:

Reason for Leaving:

May we contact?
Yes No

Work Experience 3

Employer: Address: Position Held:

From:

To:

Description of Duties:

Start Wage:

Final Wage:

Reason for Leaving:

May we contact?
Yes No

References

Authorization and Acknowledgements

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that if I am employed, any false statements on this application may be grounds for dismissal.

I authorize investigation of all statements contained in this application. I also grant permission to contact all references listed above, and authorize them to release all information concerning my previous employment and any other pertinent information these references might have, personal or otherwise. I release all parties from all liability for any damage that may result from furnishing this information to you.

I understand and agree that, if hired, my employment is for no definite period and may be terminated at any time and without prior notice.

Contact Information

Position Desired

Education

Military Experience

Work Experience

Work Experience 1

Work Experience 2

Work Experience 3

References

Reference 1

Reference 2

Reference 3

Authorization and Acknowledgements