AMERICAN PLASTIC MOLDING CORP.						Application for Employment
	PLEASE PRINT
Equal access to programs, services and employment is available to all persons.  Those applicants requiring reasonable
accommodation  to the application and/or interview process should notify a representative of the Human Resource Department.
Position(s) applied for
Name					Social Security #
	LAST		FIRST	MIDDLE
Address
	STREET				CITY	STATE		ZIP CODE
Telephone #	(        )		Mobile/ Beeper/Other Phone #		(        )		E-Mail Address
If you are under 18, and it is required, can you furnish a work permit?						Yes	No
If No, please explain
Have you ever been employed here before?   If yes, give dates and positions						Yes	No
Are you legally eligible for employment in this country?						Yes	No
Date available for work		/     /		What is your desired  salary range?			$
Types of employment desired			Full Time	Part Time	Temporary	Seasonal	Educational Co-Op
Are you able to meet the attendance requirements of the position?						Yes	No
Have you ever pled "guilty" or "no contest" to or been convicted of a crime?						Yes	No
If yes, please provide date(s) and details
ANSWERING 'YES' TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE
OF THE  VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT
Driver's license number (if driving is an essential job function)							State
Employment History
Provide the following information of your past (4) employers, assignments or volunteer activities starting with the most recent.
FROM	TO		EMPLOYER				TELEPHONE #
STARTING JOB TITLE/ ENDING JOB TITLE			ADDRESS
IMMEDIATE SUPERVISOR AND TITLE			SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
MAY WE CONTACT FOR REFERENCE?			YES                              NO                                LATER
REASON FOR LEAVING			HOURLY RATE SALARY
			START    $             PER                FINAL    $             PER
FROM	TO		EMPLOYER				TELEPHONE #
STARTING JOB TITLE/ ENDING JOB TITLE			ADDRESS
IMMEDIATE SUPERVISOR AND TITLE			SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
MAY WE CONTACT FOR REFERENCE?			YES                              NO                                LATER
REASON FOR LEAVING			HOURLY RATE SALARY
			START    $             PER                FINAL    $             PER
FROM	TO		EMPLOYER				TELEPHONE #
STARTING JOB TITLE/ ENDING JOB TITLE			ADDRESS
IMMEDIATE SUPERVISOR AND TITLE			SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
MAY WE CONTACT FOR REFERENCE?			YES                              NO                                LATER
REASON FOR LEAVING			HOURLY RATE SALARY
			START    $             PER                FINAL    $             PER
FROM	TO		EMPLOYER				TELEPHONE #
STARTING JOB TITLE/ ENDING JOB TITLE			ADDRESS
IMMEDIATE SUPERVISOR AND TITLE			SUMMARIZE THE NATURE OF WORK PERFORMED AND JOB RESPONSIBILITIES
MAY WE CONTACT FOR REFERENCE?			YES                              NO                                LATER
REASON FOR LEAVING			HOURLY RATE SALARY
			START    $             PER                FINAL    $             PER
				AN EQUAL OPPORTUNITY EMPLOYER
Skills and Qualifications
Summarize any training, skills, licenses and/or certificates that may qualify you as being able to
perform job-related functions in the position for which you are applying
Educational Background   (if job related)
Name and Location			Number of years      completed	Did you graduate?	Course of study
High School
College				Major          Degree
Other
References
Name				Phone #		Number of Years Known
				(    )
				(    )
				(    )
Applicant Statement
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (I) cancel further
consideration of this application or (ii) immediately discharge me from the employer's service, whenever it is discovered.
I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and
professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in
application, resume or job interview.  I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives for
I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any
applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
I understand that this application remains current for only 90 days.  At the conclusion of that time, if I have not heard from the employer and still wish to be considered
for employment, it will be necessary to reapply and fill out a new application.
If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my
employment at any time, with or without cause and without prior notice, except as may be required by law.  This application does not constitute an agreement or contract
for employment for any specified period or definite duration.  I understand that no supervisor or representative of the employer is authorized to make any assurances to
the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's
president.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws
require me to complete an I-9 Form in this regard.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement
Signature of Applicant					Date              -       -