Apply – TL Edwards Inc.

Applicant Instructions

Individuals who need assistance with any phase of the application process should notify the person who gave them the application to request the reasonable accommodations.

1. Complete all pages.

2. Print Clearly; incomplete or illegible applications will not be processed. PLEASE NOTE "NOT APPLICABLE" IF NOT ANSWERING QUESTIONS.

3. Provide only requested information. Failure to do so may result in disqualification of your application.

4. Some packets may include an EEOC Self Identification Form. This information is being gathered for affirmative action under Section 503 of the Rehabilitation Act of 1973. The information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire.

Position Applied For *

Today's Date *

First Name *

MI *

Last Name *

Home Phone *

Work Phone

Current Address

Street *

City *

Zip *

State *

Prior Address

Street

City

Zip

State

Professional Licenses and Certifications

Are you license/certified for the job applied for? *

Name of license/certifications

License/certification number

Issuing State

Has your license/certification ever been revoked or suspended?

If yes, state the reason(s), date of revocation or suspension, and date of reinstatement:

Drivers License Information

If the job requires, do you have the appropriate driver's license? *

Name on license

Driver's License #

Type

State of Issue

Have you had any moving violations within the last seven years? *

If yes, please describe

Do you have reliable means of transportation to get to work each day? *

References

Reference #1

Name *

Address/Phone *

Years Known/Relation *

Reference #2

Name

Address/Phone

Years Known/Relation

Reference #3

Name

Address/Phone

Years Known/Relation

Education

High School

Name

City/State

Graduated?

Degree Type

College

Name

City/State

Graduated?

Degree Type

Other

Name

City/State

Graduated?

Degree Type

Previous Employers

PLEASE NOTE: Your application may not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of the past employers are critical. Ask for a phone book or call information if necessary.

FOR EMPLOYERS OUTSIDE OF THE U.S., A CURRENT FAX NUMBER IS MANDATORY

In Massachusetts an applicant may include any verified work performed on a volunteer basis

Most Recent Employer

Are you currently working for this employer? *

May we contact? *

Phone *

Fax

Company Name *

Job Title *

Address

Dates Employed *

Salary *

USD

Per *

Supervisor Name *

Reason for Leaving *

Duties *

Second Most Recent Employer

Are you currently working for this employer?

May we contact?

Phone

Fax

Company Name

Job Title

Address

Dates Employed

Salary

USD

Per

Supervisor Name

Reason for Leaving

Duties

Applicant Note

This application form is intended for user in evaluating your qualifications for employment. This application form is not an offer of employment. If hired, such employment shall be considered "at will" and this application is not intended to constitute a contract of continued employment. False or misleading statements during the interview or on this form may result in the refusal to hire or termination of employment. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability, or any other consideration made unlawful by applicable federal, state, or local laws. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting for work, you may be required to submit to a medical review. Depending on the company policy and the needs of the job, you may be required to complete a medical history form and may be required to be examined by a medical professional designated by the company. Smoking is prohibited in all indoor areas of the Company's facilities unless designated smoking areas have been established at a particular location in accordance with the applicable state and local law.

Permission to work in the United States

Are you legally eligible to work in the united states? *

Proof of employment eligibility will be required if hired

Certification and Release

I certify that I have read and understand the applicant note on this form and that the answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information.

I release all former employers, persons, schools, companies, and law enforcement authorities from any liability for any damages whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment

Digital Initial *

Date *