Fill out Employment Application Date* Last Name* Middle Initial First Name* Present Address Street* Apartment Number City* State* ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisanaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Country Zip Code* Permanent Address Street Apartment Number City State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisanaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Country Zip Code Are you 16 years old or older?* ---YesNo Are you 18 years old or older?* ---YesNo Phone Number* Work Phone Number Email Address* Best Time to Contact You at Home Emergency Contact Emergency Contact Address Emergency Contact Phone Number Are you lawfully authorized to work in the United States* ---YesNo If you are offered employment with this company, you will be required by federal law to furnish documents showing you are either a U.S. Citizen or an authorized alien. Individuals who do not furnish these documents cannot work for the company. Position (Choose up to three)* AccountingAdministrative AssistantDrafter/DesignerContract AdministratorCustomer ServiceElectrical DesignerEngineer-DesignEngineer-ElectricalEngineer-IndustrialEngineer-Product SafetyFull Stack Software DeveloperJanitorLegal AssistantMachinery BuilderMachinistMaintenanceMaterial HandlerNetwork AdministratorOffice ManagerPainterParalegalPart Time OfficePart Time PlantPLC ProgrammerProduction WorkerPurchasingSalesSales EngineerSaw and DrillSecretaryService TechnicianSoftware Developer/EngineerStockroomTechnical WriterTier 1 IT Help Desk TechnicianWelder Date You Can Start Salary Desired Per: ---weekmonthyear Are you employed now? ---YesNo If so may we contact your present employer? ---YesNo Have you ever applied to this company before? ---YesNo When? Have you ever worked for this company before? ---YesNo When? Reason For Leaving Name of Last Supervisor at this Company Do any of your friends or relatives, other than spouse, work here? ---YesNo If yes, state Name & Relationship Who referred you to Red Bud Industries, Inc.?* ---CareerBuilderCollege – Please provide name of College in “Additional Information” field below.CraigslistCurrent Employee – Please provide name of Employee in “Additional Information” field below.FacebookGlassdoorHandshakeIllinois Department of Employment Security (IDES)Indeed.comInternet SearchJob Fair – Please provide location of Job Fair in “Additional Information” field below.Jobs.comLinkedInMonsterNewspaper – Please provide name of Newspaper in “Additional Information” field below.Red Bud Chamber of CommerceRed Bud Industries’ SignRed Bud Industries’ WebsiteSchool – Please provide name of School in “Additional Information” field below.Zip RecruiterOther – Please provide brief explanation if not listed above in Additional Information” field below. Additional Information Are you available to work: What shift are you available to work? Full Time 1 Shift2 Shift3 Shift Part Time MorningsAfternoonsEvenings Temporary Please indicate dates available Are you currently on "lay-off" status & subject to recall? ---YesNo Can you travel if a job requires it? ---YesNo Education Grade School Name & Location of School Years Completed Did you graduate? ---YesNo High School Name & Location of School Years Completed Did you graduate? ---YesNo Courses of Study Undergraduate / Graduate / Other (Specify) Name & Location of School Years Completed Did you graduate? ---YesNo Courses of Study Additional Information YOU MAY EXCLUDE MEMBERSHIP WHICH WOULD REVEAL GENDER, RACE, RELIGION, NATIONAL ORIGIN, AGE, ANCESTRY, DISABILITY, OR OTHER PROTECTED STATUS DESCRIBE ANY SPECIALIZED TRAINING, APPRENTICESHIP, SKILLS & EXTRA-CURRICULAR ACTIVITIES: DESCRIBE ANY JOB-RELATED TRAINING RECEIVED IN THE UNITED STATES MILITARY: LIST PROFESSIONAL, TRADE, BUSINESS, OR CIVIC ACTIVITIES. Other Qualifications SUMMARIZE SPECIALIZED SKILLS, EQUIPMENT OPERATED, & OTHER JOB-RELATED SKILLS & QUALIFICATIONS ACQUIRED FROM EMPLOYMENT OR OTHER EXPERIENCE. STATE ANY ADDITIONAL INFORMATION YOU FEEL MAY BE HELPFUL TO US IN CONSIDERING YOUR APPLICATION. Work Experience START WITH YOUR PRESENT OR LAST JOB. INCLUDE ANY JOB-RELATED MILITARY SERVICE ASSIGNMENTS AND VOLUNTEER ACTIVITIES. YOU MAY EXCLUDE ORGANIZATIONS WHICH INDICATE RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, DISABILITIES,OR OTHER PROTECTED STATUS. Present Employer Name & Address of Employer Starting Date (month/year) Weekly Starting Salary Weekly Current Salary Job Title Name & Title of Supervisor Phone Number Description of Work: Previous Employer 1 Name & Address of Employer Starting Date (month/year) Leaving Date (month/year) Weekly Starting Salary Weekly Final Salary Job Title May we contact your supervisor? ---YesNo Name & Title of Supervisor Phone Number Description of Work: Reason for leaving Previous Employer 2 Name & Address of Employer Starting Date (month/year) Leaving Date (month/year) Weekly Starting Salary Weekly Final Salary Job Title May we contact your supervisor? ---YesNo Name & Title of Supervisor Phone Number Description of Work: Reason for leaving Previous Employer 3 Name & Address of Employer Starting Date (month/year) Leaving Date (month/year) Weekly Starting Salary Weekly Final Salary Job Title May we contact your supervisor? ---YesNo Name & Title of Supervisor Phone Number Description of Work: Reason for leaving Previous Employer 4 Name & Address of Employer Starting Date (month/year) Leaving Date (month/year) Weekly Starting Salary Weekly Final Salary Job Title May we contact your supervisor? ---YesNo Name & Title of Supervisor Phone Number Description of Work: Reason for leaving Previous Employer 5 Name & Address of Employer Starting Date (month/year) Leaving Date (month/year) Weekly Starting Salary Weekly Final Salary Job Title May we contact your supervisor? ---YesNo Name & Title of Supervisor Phone Number Description of Work: Reason for leaving Previous Employer 6 Name & Address of Employer Starting Date (month/year) Leaving Date (month/year) Weekly Starting Salary Weekly Final Salary Job Title May we contact your supervisor? ---YesNo Name & Title of Supervisor Phone Number Description of Work: Reason for leaving References GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR. Reference 1 Name Address Business Phone Number Best Time to Call Years Acquainted Reference 2 Name Address Business Phone Number Best Time to Call Years Acquainted Reference 3 Name Address Business Phone Number Best Time to Call Years Acquainted Application for Employment This company is an Equal Opportunity/Affirmative Action Employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status. In connection with your application for employment, you may be required to take a written pre-employment test. We will provide accommodations in the testing process for disabled individuals. If you require any accommodations in the testing process, please notify your personnel interviewer. Applicant Statement It is understood and agreed the information that I have provided on this application is true and complete to the best of my knowledge. Any misrepresentation or omission of any fact in my application, resume, test scores, or any other materials, or during any interview, can be justification for refusal of employment, or, if employed, termination from the company's employment, regardless of when or how it was discovered. For employment purposes as may be necessary in arriving at an employment decision, I give the company the right to investigate all statements contained herein and the references, including past employers listed, and to secure additional information about me, whether personal or otherwise. In connection with this application, certain positions require an investigative report which may include a credit report, criminal record report, and/or a motor vehicle report. If any such report is needed, I will be notified in advance to obtain my written consent. I understand that a poor credit history and/or a conviction will not automatically result in disqualification from employment. I hereby release the company and its representatives from all liability for any damage that may result from seeking or utilization of such information as well as all those who furnish such information. I understand that I am subject to a urinalysis for drug testing purposes and physical examination. The results of such examinations will be made available to the company. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I understand that the company is an Equal Opportunity Employer and does not discriminate in employment and no question on this application is to be used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state, or Federal law. 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. In consideration of my employment, I agree to comply with the policies, rules, regulations, and procedures of the company which are established and maintained from time to time, and I understand that the company reserves the right to change wages, hours and working conditions as deemed necessary. I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, UNLESS OTHERWISE DEFINED BY APPLICABLE LAW, ANY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION IS OF AN "AT WILL" NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE EMPLOYEE AT ANY TIME WITH OR WITHOUT CAUSE. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I understand that any employment offer is contingent upon my providing, within three working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986. I further understand that this application for employment is not a contract for employment. Mechanical Test We may ask that you take a mechanical test because our business requires high mechanical ability. This is not an intelligence test. Low test scores do not reflect on one's personal character or overall talent. Thank you for applying at our company. By checking this box, I have read and fully understand and agree with the above information. I Understand* Background Information Your work history will be discussed with you if you are interviewed. Please answer all the following questions with yes or no. Have you ever been: Placed on probation or terminated for poor job performance?* ---YesNo Disciplined or fired for insubordination?* ---YesNo Disciplined or discharged for violating a safety rule?* ---YesNo Disciplined or terminated for absenteeism, tardiness, failure to notify your company when absent, or any other attendance-related reason not relating to medical issues?* ---YesNo Disciplined or fired for fighting, assault, or similar offenses?* ---YesNo Disciplined or discharged for being under the influence of alcohol or drugs, or for possession, use or abuse of alcohol or drugs during the course of employment?* ---YesNo Have you ever been employed by The Material Works?* ---YesNo Are you a relative of anyone who currently works for or was employed in the past by The Material Works?* ---YesNo If so, please list name. I UNDERSTAND THAT IF I AM SELECTED FOR AN INTERVIEW OR UPON A JOB OFFER BEING EXTENDED TO ME, THAT THE COMPANY WILL REQUIRE THAT I COMPLETE A CONVICTION INQUIRY QUESTIONNAIRE. By checking this box, I certify that the above answers are true to the best of my knowledge. I understand that any falsification discovered before or after I am employed may be cause for my being disqualified or removed from employment with the company. I Understand* By submitting this information, I authorize to Red Bud Industries that I have read and fully understand & agree with the information included in this submission. *** THE COMPANY IS AN AT-WILL, EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER *** Click here to view Red Bud Industries, Inc.’s Privacy Policy. I hereby consent to Red Bud Industries, Inc.’s Privacy Policy.*
