Date of Application Submission
*
MM
DD
YYYY
First and Last Name
*
First Name
Last Name
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone Number
*
(###)
###
####
Driver License Number
Social Security Number
*
Email
*
Are you legally eligible for employment in the US?
*
Are you at least 18 years of age?
*
Are you able to perform the functions of the job(s) for which you have applied, with or without a reasonable accommodation?
*
If no, please describe any functions which you are not able to perform with or without reasonable accommodations.
*
Do you have a resume?
*
Type of Employment Desired
*
Full-Time
Part-Time
Temporary
Seasonal
Educational Co-Op
Desired Hourly Wage or Salary
*
Earliest Date Available
*
MM
DD
YYYY
Are you willing to travel?
*
Are you willing to relocate?
*
Have you ever been employed by Alsey Refractories?
*
If yes, please provide most recent date of employment at Alsey.
MM
DD
YYYY
Source of Referral
*
Advertisement
Walk-In
Employee
Relative
Private Employment Agency
Government Employment Agency
Other
If other, please explain.
If you have ever used another name for employment purposes, please indicate in the space provided below and explain. If not, please enter N/A.
*
Company Name
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Supervisor's Name and Title
*
Supervisor's Phone Number
*
(###)
###
####
Your Job Title
*
Hire Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Current Job Status
*
Detailed Description of Your Responsibilities In this Position
*
Reason for Leaving/Wanting to Leave
*
May we contact this employer for reference?
*
Company Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Supervisor's Name and Title
Supervisor's Phone Number
(###)
###
####
Your Job Title
Hire Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Current Job Status
Detailed Description of Your Responsibilities In this Position
Reason for Leaving/Wanting to Leave
May we contact this employer for reference?
Company Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Supervisor's Name and Title
Supervisor's Phone Number
(###)
###
####
Your Job Title
Hire Date
MM
DD
YYYY
End Date
MM
DD
YYYY
Current Job Status
Detailed Description of Your Responsibilities In this Position
Reason for Leaving/Wanting to Leave
May we contact this employer for reference?
01. Company Name
Employer Phone Numer
(###)
###
####
Is it okay to contact this employer?
02. Company Name
Employer Phone Number
(###)
###
####
Is it okay to contact this employer?
03. Company Name
Employer Phone Number
(###)
###
####
Is it okay to contact this employer?
04. Company Name
Employer Phone Number
(###)
###
####
Is it okay to contact this employer?
05. Company Name
Employer Phone Number
(###)
###
####
Is it okay to contact this employer?
06. Company Name
Employer Phone Number
(###)
###
####
Is it okay to contact this employer?
07. Company Name
Employer Phone Number
(###)
###
####
Is it okay to contact this employer?
Name of High School
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Did you graduate from High School?
How many years of High School completed?
Name of College or University
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Did you graduate from College or University?
How many years of College or University completed?
Course of Study/Degree Earned
Name of Trade School
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Did you graduate?
How many months/years of Trade School completed?
Name of Certificate Earned
Please List Any Extracurricular Activities You Were Involved in During School
Member of Professional Organizations
Honors Received, Volunteer or Community Service or Other Qualifications You Have Which You Feel Are Related to the Position for Which You Are Applying
Were you in the US Armed Forces?
*
If yes, what branch?
Starting Date of Duty
MM
DD
YYYY
Ending Date of Duty
MM
DD
YYYY
Your Rank and Pay Grade Upon Discharge
01. Type
Organization or State Issued
Date Issued
MM
DD
YYYY
Number
Verification
02. Type
Organization or State Issued
Date Issued
MM
DD
YYYY
Number
Verification
03. Type
Organization or State Issued
Date Issued
MM
DD
YYYY
Number
Verification
01. Personal Reference
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Occupation
02. Personal Reference
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Occupation
03. Personal Reference
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Occupation
01. Employer Reference
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Occupation
02. Employer Reference
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Occupation
03. Employer Reference
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Occupation
DISCLAIMER OF LIABILITIES
*
1. If I am offered employment, I understand that I may be required to take a post-offer medical examination before beginning work, in which case Alsey Refractories’ offer of employment will be conditioned upon my satisfactory completion of this exam.
When a post-offer medical examination is required, it will be required of all entering employees in the same job category, and the information obtained in the course of the examination will be treated as a confidential medical record.
I consent to taking a pre-employment drug test and understand that any offer of employment by Alsey Refractories will also depend on my satisfactory completion of this test. I also consent to any drug test administered during my employment by Alsey Refractories performed pursuant to its then current Substance Abuse and Drug Testing Policy.
2. If I am offered employment that requires driving as an essential function, I understand that the offer may be subject to proof of a good driving record and my ability to comply with all driving laws.
3. The information contained in this application is true to the best of my knowledge and belief. I understand that any misrepresentation of fact, as stated or implied, given in my application, interview(s) or any other employment form, may be sufficient reason not to hire me and may be reason for dismissal.
I understand and agree that all information furnished in this application may be verified by Alsey Refractories or its authorized representative. I waive any right I may have to notice from any individuals and organizations named or referred to by me in this application prior to the release of any employment information to Alsey Refractories. I hereby authorize all individuals in organizations named or referred to in this application and any law enforcement organization to give Alsey Refractories all information relative to such verification and hereby release such individuals, organizations and Alsey Refractories from any and all liability for any claim or damage resulting therefrom.
4. I understand that, if hired, I am required to abide by all rules and regulations of Alsey Refractories and to comply with all policies and procedures in an employee handbook, any policy and procedure manual or other communications to employees including but not limited to safety rules. I further understand that Alsey Refractories’ policies and procedures are subject to modification without notice.
I understand that Alsey Refractories is not obligated to provide employment and that I am not obligated to accept employment. Nothing in this application, or in any prior or subsequent oral or written statement, is intended to create any contract of employment or to create any rights in the nature of a contract of employment. I understand that, if I am hired, nothing in this application shall restrict the right of Alsey Refractories to terminate my employment at any time.
