Hayes Industries Employment Application

We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons.

Personal Information

Last Name

First Name

Middle Init.

Email Address

Telephone Number

Street Address

City

State

Zip Code

Can you submit proof of legal employment authorization and identity?

Are you 21 years of age or older?

Driver's Licence No.

Issuing State

If you are under age 18, can you furnish a work permit if required?

Are you currently employed?

If so, may we contact your current employer?

Have you ever been convicted of a crime?*

* A yes response does not automatically disqualify a job applicant from further consideration. Each Application is evaluated individually, based on a number of factors including the nature of the crime, how long ago the crime and/or release from incarceration occurred, whether a sufficient or satisfactory work record has been established since the crime and/or release from incarceration, and the position applied for.

Identify all misdemeanor and felony convictions:

How were you referred to us?

Employment Desired

What position(s) are you applying for?

List any courses and seminars completed and NOT included in your education above.

Description

Completion Date

Licenses/Ceritifications/Registrations

Description

Number

Issue Date

Issued By

Expire Date

Issue State

Professional Memberships

Name of Organization

Membership Date

Employment History

Provide at least your last three employers, if available. Start with present or most recent employer and click the ADD button for additional employers.

Employer Name

Telephone Number

City

State

Zip Code

Supervisor's Name

May we contact your supervisor?

Start Date

End Date

Final Salary

Position Held

Reason for Leaving

Duties

Authorization

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal, or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company 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, unless it is in writing and signed by an authorized company representative."

Signature
Typing your name in the box above will constitute an electronic signature.

Date