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Employment Application

* required fields

	General Information
Name First/Middle/Last	Date
Are you 18 years of age or older?	Yes    No *Hire is subject to verification that you are of minimum legal age.
Are you a US Citizen?	Yes    No    If not a U.S. Citizen, what type of visa do you have?
Are you legally eligible for employment in the U.S.?	Yes    No   *Proof of U.S. citizenship or immigration status is required upon employment.
	Current Address
Home Address
City	State/Province   state/province ------------------------- Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon   Zip/Postal
Work Address
City	State/Province   state/province ------------------------- Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon   Zip/Postal
	Contact Information
Home No.	Work No.     *E-mail
	Position Information
Type of Position Desired	Full Time   Part Time   Shift Work   Temporary
Salary Desired	Date Available for Employment
How did you hear about Coresix Precision Glass, Inc.?	Advertisement    Employment Agency    Internet    Walk-In Referral, Coresix Employee    Other
	Career Objectives
Please describe the type of work you are most interested in, the abilities you possess, and the lines along which you want your career to develop.
	Education
High School	Location      Dates From/To
Did you graduate?	Yes   No    Academic Years/Credit      Degree/Date
Major Subject	Grade Point Average
Business/Technical	Location      Dates From/To
Did you graduate?	Yes   No    Academic Years/Credit      Degree/Date
Major Subject	Grade Point Average
College 1	Location      Dates From/To
Did you graduate?	Yes   No    Academic Years/Credit      Degree/Date
Major Subject	Grade Point Average
College 2	Location      Dates From/To
Did you graduate?	Yes   No    Academic Years/Credit      Degree/Date
Major Subject	Grade Point Average
	Specialized Training
Describe any other specialized training (such as technical, correspondence, or night school courses)	*Specify professional designations, certifications, licenses, or registrations held.
	Employment History Please begin with your present or last position.
Company 1	Address      Dates From/To
Starting Salary	Ending Salary      Job Title
Supervisor's Name and Title	Phone
May we contact this company?	Yes   No    Reason for leaving
Responsibilities
Company 2	Address      Dates From/To
Starting Salary	Ending Salary      Job Title
Supervisor's Name and Title	Phone
May we contact this company?	Yes   No    Reason for leaving
Responsibilities
Company 3	Address      Dates From/To
Starting Salary	Ending Salary      Job Title
Supervisor's Name and Title	Phone
May we contact this company?	Yes   No    Reason for leaving
Responsibilities
	Special Skills and Qualifications
Special skills and qualifications acquired from employment or other experience
List machines you can operate
Additional Information
Certification - I certify the foregoing information to be complete and correct in all respects. I understand that if any part is found incomplete or false, it will be sufficient grounds for refusal to employ me, or, if I am employed, for disciplinary action including dismissal of that employment. I authorize Coresix Precision Glass, Inc. to conduct any investigation it deems necessary in connection with this information. I release from all liability any and all person s or entities who may, in response to inquiry by Coresix Precision Glass, Inc. furnish accurate information pertaining to my personal and/or employment history, and Coresix Precision Glass, Inc. is in its use of such information. If employed by Coresix Precision Glass, Inc., I agree to abide by all company rules, policies, and procedures. I understand that no representative or official of Coresix Precision Glass, Inc. is authorized to make any verbal promises concerning employment or conditions thereof except as confirmed in writing by the President. I further agree, if employed that I will work efficiently and diligently, to be careful and avoid accidents, and to come to work at the proper time every workday. In compliance with Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to Coresix Precision Glass, Inc 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 approved documents that are required. I understand that employment at this company is “at will”, which means that either I or Coresix Precision Glass, Inc. 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. An Equal Opportunity Employer M/F/V/H - Applicants are considered for positions without regard to race, color, religion, sex, national origin, age, marital, veteran status, or handicap. THIS APPLICATION FOR EMPLOYMENT WILL BE REMOVED FROM OUR ACTIVE FILES AFTER 90 DAYS UNLESS RENEWED BY APPLICANT.
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