Portage Plastics
Application for Employment


Directions: Complete form press the submit button at the bottom of the page.

All applicants will be considered for employment without regard to race, religion, color, sex, national origin, age, mental or veteran status, or any other status protected by law. We are an Equal Opportunity Employer.
 
Personal
Last Name     First Name     Middle Initial  
Date     Social Security Number     Phone  
Street Address     City     State     Zip  
Referred by:   Advertisement   Emp Agency   Friend/Relative   Other   None  
Age if under 18    
Are you legally eligible for permanent employment in the United States?   (If hired, verification will be required by law.)
Position(s) applied for     Full Time   Part Time  
Specify days/hours     Rate of pay expected   $   per
Have you worked for us before?     If yes, when?     Position  
Indicate special qualifications or skills    


Education
Name & Location of School Course of Study Years Completed Graduated?
Elementary  
High School  
College  
Other  

Describe any other training or education:


Military Service
Branch of Service     From   To
Rank & Duties   Date Discharged


Work References (no friends or relatives)
Name Address Years Known Phone


Prior Employment (start with the most recent employer)
Employer     Phone   From     To  
Street Address   Position  
City, State, Zip   Supervisor's Name  
Duties   Starting Salary/Wages  
Reason for Leaving   Final Salary/Wages  

Employer     Phone  
From     To  
Street Address   Position  
City, State, Zip   Supervisor's Name  
Duties   Starting Salary/Wages  
Reason for Leaving   Final Salary/Wages  

Employer     Phone  
From     To  
Street Address   Position  
City, State, Zip   Supervisor's Name  
Duties   Starting Salary/Wages  
Reason for Leaving   Final Salary/Wages  


PLEASE READ BEFORE SUBMITTING
Pre-employment drug screening is a prerequisite for employment at Portage Plastics Corporation. The collection and analysis of the urine specimen is paid for by the Company. The specimen is split into two samples, if there is a positive test the prospective employee may request that the second sample be tested for accuracy at his/her expense. If the result is negative, Portage Plastics Corporation will reimburse that individual the cost of the retest.

Any individual who has not been selected for employment, due to the pre-employment screening results, may reapply six months from the test.

The above information is true and complete to the best of my knowledge. Should I be employed by the company, any misrepresentation or false statement contained herein may be considered cause for possible dismissal. The Company has my permission to verify any and all information provided by me on this application. I release all parties from written notice to me.

Regardless of whether or not I become employed by the company, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at Portage Plastics Corporation is on an at-will basis and that my employment may be terminated with or without cause, and without notice at any time, at my option or the company's.

I, , read and agreed to the above statement on today, .

   


Thank you for your interest in Portage Plastics Corporation.