Application For Employment

Last Name
First Name
Middle Name or Initial
Street Address
City
State
ZIP
Date Of Birth (MM/DD/YYYY)
Telephone Number
Email Address:
Are You a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation)


 		Yes
No
Are you looking for full-time employment?


 		Yes
No
If no, what hours are you available?
Date available to start if hired by AutoNumatic Corp. (MM/DD/YYYY)
Have you ever been convicted of a felony? ( This will not necessarily affect your application) Yes
No
If yes, please describe conditions.
Position Applied For
How did you hear of this opening?
Have you ever applied for employment with AutoNumatic Corp. or its subsidiaries in the past? Yes
No
Have you been employed by AutoNumatic Corp. or any of its subsidiaries in the past? Yes
No
Are you currently employed? Yes
No
May we contact your current employer? Yes
No
Name of supervisor or contact at current employer:
Current supervisor or contact phone number:
Current Employer Address:

Education
Please select the highest level of education compleated: High School Diploma or Equivalent
Associates Degree
Bachelors Degree
Post Graduate Degree
Other Technical or Occupational Training
Are you currently attending school? Yes
No
Please list any courses of study that may be beneficial to your employment at AutoNumatic Corp.
In addition to your work history, are there any other skills, qualifications, or experience that we should consider?

Employment History

( Start with your current or most recent employer)

Company Name:
Company Address
Telephone Number:
Supervisor Name:
May we contact?


 		Yes
No
Date Started: (MM/DD/YYYY)
Date Ended: (MM/DD/YYYY)
Starting Position:
Ending Position:
Starting Wage:
Ending Wage:
Summary of job responsibilities:
Reason for leaving:
Company Name
Company Address
Telephone Number:
Supervisor Name:
May we contact? Yes
No
Date Started: (MM/DD/YYYY)
Date Ended: (MM/DD/YYYY)
Starting Position:
Ending Position:
Starting Wage:
Ending Wage:
Summary of job responsibilities:
Reason for leaving:
Company Name
Company Address
Telephone Number:
Supervisor Name:
May we contact? Yes
No
Date Started: (MM/DD/YYYY)
Date Ended: (MM/DD/YYYY)
Starting Position:
Ending Position:
Starting Wage:
Ending Wage:
Summary of job responsibilities:
Reason for leaving:
If you have a copy of your resume, you may upload it here. Please upload as a .PDF or a Word Document.

Please Read Before Signing Digitally:

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record.

I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.

I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.

In consideration of Auto Numatic Corporation’s review of my application for employment, I hereby voluntarily consent to and authorize Auto Numatic Corporation to obtain a criminal background history.
Please Type Your Full Name:
Date: (MM/DD/YYYY)