Employment Application Stanton Automatics, IncAPPLICATION FOR EMPLOYMENT We appreciate your interest in our organization. To be considered for employment, this Employment Application must be completed and signed personally by the applicant. Each question must be answered in full, even if a resume is provided. If an answer is NO or NOT APPLICABLE, indicate such. We are an Equal Opportunity Employer. We consider all applicants for all positions without regard to race, religion, creed, color, sex, age, national origin, disability, sexual orientation, gender identity, transgender status, gender dysphoria, marital or family status, pregnancy, military/veteran status, genetic information including predisposing genetic characteristics or carrier status, arrest or conviction record, domestic violence victim status, or any other protected class or status, in accordance with applicable federal, state, and local regulations. Applicants requiring a reasonable accommodation to participate in the application and/or interviewing process should notify an organization representative. BIOGRAPHICAL DATAName (First, Middle, Last) *Telephone Number *Email *Cell Phone Number Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryPosition Applied For *Days Available to Work *SundayMondayTuesdayWednesdayThursdayFridaySaturdayShift Availability *Full-TimePart-TimeTemporaryShift WorkDayEveningNightDate Available to Begin Work *Are you 18 years of age or older? *YesNoAre you currently employed? *YesNoIf yes, may we contact your employer? YesNoHave you submitted an application and/or interviewed for employment with our organization? *YesNoIf yes, give dates and position Have you ever been employed with our organization before? *YesNoIf yes, give dates From To Are you legally eligible for employment in the United States? *YesNoIf you have had an opportunity to review a job description for the position for which you are applying, can you perform the essential functions of this job with or without reasonable accommodation? (check N/A if you have not reviewed a job description) *YesNoN/A EDUCATIONAL BACKGROUNDHigh SchoolName and Location of School *Course of Study/Major *Years Completed *Diploma or Degree Earned *DiplomaGEDCollege/UniversityName and Location of School Course of Study/Major Years Completed Diploma or Degree Earned AssociateBachelorGraduate SchoolName and Location of School Course of Study/Major Years Completed Diploma or Degree Earned MasterDoctoralTrade SchoolName and Location of School Course of Study/Major Years Completed Diploma or Degree Earned Certificate SKILLSList any additional skills, training, and/or technical/professional knowledge that is relevant to the job for which you are applying List any certificates, licenses, or professional achievements that would support your qualifications for employment Drivers’ License Identification Numbe State of Issuance EMPLOYMENT HISTORYProvide employment information, including military service starting with the most recent employer first. If you've held more than three jobs, provide this information on another sheet and attach to this Application Form. Employer #1Name of Employer *Supervisor *May we contact? *YesNoAddress *Phone Number *Job Title *Dates Employed (Month/Year) *To *Description of Duties, Responsibilities and Significant Accomplishments *Reason for Leaving *Employer #2Name of Employer Supervisor May we contact? YesNoAddress Phone Number Job Title Dates Employed (Month/Year) To Description of Duties, Responsibilities and Significant Accomplishments Reason for Leaving Employer #3Name of Employer Supervisor May we contact? YesNoAddress Phone Number Job Title Dates Employed (Month/Year) To Description of Duties, Responsibilities and Significant Accomplishments Reason for Leaving REFERENCES (List three references other than relatives)Reference #1Name *Relationship *Phone Number or Email *Reference #2Name Relationship Phone Number or Email Reference #3Name Relationship Phone Number or Email CONVICTION RECORD STATUS All applicants and employees must, as a condition of employment, inform the organization of all convictions. This includes all convictions received within the past seven years, while your application for employment is pending, and within seven days of receiving a conviction if currently employed.Have you been convicted of, and/or plead guilty to, a felony or misdemeanor in the past seven years? *YesNoDo you have any pending criminal charges against you at this time? *YesNo PLEASE READ CAREFULLY I hereby certify that all of the information I have provided on this Employment Application is true and correct to the best of my knowledge. I understand that any falsification or omission of facts will disqualify me from further consideration of employment, withdrawal of any offer of employment, or, termination of employment if already hired. I authorize verification of all of the information I have provided on this Employment Application and understand that additional information may be needed to consider my application for employment. I authorize all previous employers, educational institutions, references, and other persons who have knowledge of me or my records to provide any and all information pertinent to my employment and release the same from any liability resulting from providing such information. I also release this organization and all of its employees from all liability for any damage that may result from reliance on the information furnished. The organization is committed to providing a drug and alcohol-free workplace. After receiving a conditional offer of employment, I understand that a drug test will be required before starting work. If the results of the test are positive, I understand that the offer of employment will be withdrawn. I understand that if employed, I am required to abide by all policies, procedures, rules, and regulations of the organization. I also understand and agree that, if hired, my employment is “at-will” and is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated by myself or the organization at any time with or without cause or notice.