APPLICATION FOR EMPLOYMENT

To Applicant: We deeply appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications and may assist us in possible future upgrading.

Speedgrip Chuck Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, national origin, sex, ancestry, or on the basis of handicap unrelated to your ability to perform the work for which you applied. No question on this application is intended to secure information to be used for such discrimination.

The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age and Speedgrip Chuck Company fully adheres to the spirit and rules of this Act.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed.

Do you have any impairments (physical, mental or medical) which would interfere with your ability to do the job for which you have applied? If so, please explain:

Speedgrip Chuck Company will make all reasonable and practical arrangements to accommodate for any employee's handicaps and physical or mental limitations.

Information contained in this section will be used only to the extent that it is relevant to the qualifications and position for which you apply. At least the city and state must be included in the address.

Starting with PRESENT or MOST RECENT, list all previous employers. List only employers located within the United States. Include self-employment, summer and part time jobs.

If applying for a nonexempt office position, indicate what office machines and equipment you have operated or skills you have acquired through training or experience.

If Applying for an hourly, non-exempt position, please summarize manufacturing training and experience below.

Give two personal references (other than employers, family, or relatives) who are mature persons and who have known you for the past (5) years or more.

Please be aware that all applicants for employment may be required to submit to urinalysis, blood tests or other screening, as part of a pre-employment physical examination, for the purpose of detecting the presence of alcohol or illegal drugs. Applicants tested will be required to sign a Consent/Release form prior to testing, and any applicant refusing to sign any required form will be disqualified from further consideration.

If you have any questions regarding this statement or questions contained on this application, please ask them of an employment interviewer before signing.

I affirm that information contained in this application is true and complete and that any misrepresentation, falsification, or omission, heron, shall be sufficient reason for dismissal from, or refusal of, employment. Further, I authorize and release Speedgrip Chuck Company to investigate and verify any one or more of my statements and answers contained on this application.

Additionally, I hereby authorize and release all my former employers, educational institutions, and other references reflected on this application to answer any inquires or questions of Speedgrip Chuck Company. As a precondition to employment, I agree to submit upon request to a physical examination to be performed at company expense by a physician designated by the company. If selected for employment and as a condition of continued employment, I further agree to submit upon request and at company expense to physical examinations to be performed by a physician designated by the company.

If employed by Speedgrip Chuck Company and as consideration for such employment, I agree that during and after such employment, I will not divulge or appropriate to my own use or the use of others, except as you authorize or direct, any secret or confidential information or knowledge obtained by me during such employment. 

I understand that if hired, I have the right to terminate my employment at any time, with or without cause and with or without notice. I further understand that Speedgrip Chuck Company has the same right. In addition, I understand and agree that no one except the President of Speedgrip Chuck Company has the authority to enter into any agreement contrary to the previous statements, and then only if it is in writing and signed by the President.