APPLICATION

Phone: *

NOTICE TO APPLICANTS

Our Company is a DRUG-FREE WORKPLACE

Screening tests for illegal drug use may be required before hiring and during your employment here.

Dates Attended: *

Company:

Reason for Leaving:

Address

Company:

Address

Dates of Employment

Address

Did you graduate?

Yes

Web-Cote Industries

APPLICATION FOR EMPLOYMENT

Address

If other than honorable, explain:

Email: *

Previous Employment

Disclaimer and Signature

Dates of Employment

By clicking the SUBMIT button, I agree to the following:

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.

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.

Dates of Service:

Other Education (school/course name and location)

Relationship:

Education

Branch:

Company #2:

Responsibilities

Relationship:

Signature: *

Phone

Company #1:

Rank at Discharge:

Major/Degree:

Job Title:

CURRENTLY HIRING FOR THE POSITIONS IN BLUE BELOW:

General Laborer

Machine Operator

Packing & Assembly

Click the name of the position for more information

Phone

NOTE: after clicking SUBMIT, screen may appear blank -- please scroll back to the top of the application where you will see the confirmation that your application has been submitted.

Relationship:

May we contact your previous supervisor for a reference?

Yes

Company #3:

Supervisor:

Reason for Leaving:

If no, are you authorized to work in the U.S.?

Yes

May we contact your previous supervisor for a reference?

Yes

Supervisor:

Type of Discharge:

Responsibilities

Military Service

Supervisor:

Name of Reference #2

May we contact your previous supervisor for a reference?

Yes

Position Applying for:

Did you graduate? *

Yes

Address

If yes, when?

Job Title:

High School (H.S. name and location) *

Dates of Employment

Dates Attended:

Name of Reference #1

Are you a citizen of the United States? *

Yes

Phone

Applicant Information

Address

Responsibilities

Company:

Name of Reference #3

References Please list three professional references

Special Skills:

Phone

College (College name and location)

Address: *

Job Title:

Course of study:

Phone

Reason for Leaving:

Full Name: *

Have you ever worked for this company? *

Yes

PLEASE, NO PHONE CALLS OR DROP IN'S

We will contact you if we are interested in an interview