APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION – Please PRINT all information clearly.

Name: (The field is required)

Date:

Address:

Primary Phone Number: (The field is required)

Secondary Phone Number:

Email Address:

Are you eligible to work in the U.S?
Yes No

Are you at least 18 years or older?
Yes No

Have you ever been terminated from employment or asked to resign by an employer?
Yes No

If yes, please provide company names and details

SHIFT AVAILABILITY

SHIFT(S) YOU PREFER:
First Second Third 12am-12pm 12pm-12am

PLEASE NOTE: ALL SHIFTS ARE REQUIRED TO WORK WEEKENDS AND HOLIDAYS

EMPLOYMENT DESIRED

Date you can start:

Position you are applying for:

REFERRAL SOURCE

How did you hear about us or who referred you?

Have you ever worked for this company before (Edge Plastics or Jobs on Site at Edge Plastics)?
Yes No

If yes, when?

Do you know anyone who works for our company?
Yes No

If yes, who?

ESSENTIAL FUNCTIONS OF JOBS AT EDGE PLASTICS:

All production positions require the ability to bend, squat/kneel, twist/turn, climb, reach above shoulders, lift up to 50 lbs. and push/pull up to 35 lbs. The job duties also require repetitive motion of the wrist, arm and waist (bending/twisting). Job duties often require standing for extended periods of time and traversing the length of warehouse. Some positions such as tow motor operators and CDL drivers require additional physical requirements pertaining to certifications.

Are you able to perform the essential functions of the job for which you are applying,
with or without a reasonable accommodation?
Yes No

EMPLOYEE HISTORY

EDUCATION

High School

Name and location of school:

Number of years attended:

Degree received? (yes or no)

Subjects studied/Major

College or University

Name and location of school

Number of years attended:

Degree received? (yes or no)

Subjects studied/Major

Trade, Business or Correspondence School

Name and location of school

Number of years attended:

Degree received? (yes or no)

Subjects studied/Major

EMPLOYMENT HISTORY

Include your last five (5) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employer 1:

Name of Employer:

Employment Dates
From:

To:

Pay / Salary:

Location / City:

Phone Number:

Supervisor’s Name:

Reason for Leaving:

Employer 2:

Name of Employer:

Employment Dates
From:

To

Pay / Salary:

Location / City:

Phone Number:

Supervisor’s Name:

Reason for Leaving:

Employer 3:

Name of Employer:

Employment Dates
From:

To:

Pay / Salary:

Location / City:

Phone Number:

Supervisor’s Name:

Reason for Leaving:

REFERENCES

Give the names and phone numbers of three persons not related to you, whom you have known at least three (3) years.

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

APPLICATION DISCLAIMER AND SIGNATURE—PLEASE READ BEFORE SIGNING

This application will become inactive after 1 year (12 mo.). If you wish to be considered for employment after that time, you must complete a new application for employment.

Edge Plastics does not discriminate against qualified applicants or employees on the basis of race, creed, nation origin, sex, ancestry, color, age, disability, or veteran status or other status or condition protected by applicable law. We insist that all of our employees perform the essential functions of their employment and have the character, integrity, and general reputation of honesty, and be a person we would be willing to have represent our Company in its dealing with our clients, suppliers, and/or other employees. Accordingly, we insist on complete honesty. ANY DISCOVERY AT ANY TIME THAT AN APPLICANT HAS FALSIFIED ANY INFORMATION ON THIS APPLICATION WILL BE GROUNDS FOR IMMEDIATE TERMINATION.

I authorize Edge Plastics to contact any former employer or other reference that I have listed on this application for employment. I further authorize Edge Plastics to verify any other information I have provided on this application. I hereby agree to release and hold harmless any past employer or listed reference against any action or recourse, claim, demand, or liability resulting directly or indirectly from this investigation. All information given by me in this application is complete. I understand that if at any time it is determined that information included on this application is not accurate and complete, any employment with Edge Plastics will be terminated immediately.

I further understand that all employees of Edge Plastics are employees-at-will, subject to discipline or dismissal without notice or cause, at the discretion of Edge Plastics. In the event that I am hired by Edge Plastics, my employment will be as an employee-at-will, which means that I have the right to terminate my employment relationship with the Company at any time with or without cause, and Edge Plastics has the right to terminate the employment relationship with me at any time with or without cause. Unless specifically in writing, signed by the President of the Company, no employee or agent of Edge Plastics has the ability to supersede the status of employment-at-will by any statements or acts either expressed or written.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that any false or misleading information in my application may result in my immediate termination.

Applicant’s printed name:

Applicant’s Signature

Today's Date:

Message/Cover Letter (optional)

Criminal Background Screening Disclaimer and Signature – Please Read Before Signing

AGREEMENT TO SUBMIT TO A PRE-EMPLOYMENT BACKGROUND SCREENING

I understand and agree that prior to employment at Edge Plastics that I am being asked to submit to a pre-employment criminal background screening. I also understand that successful passing of a criminal background screening is only one consideration that Edge Plastics makes in considering me for an offer of employment, and if there are questions related to anything that is found in my criminal background screening, Edge Plastics will discuss those findings with me on an individualized basis.

I understand that the following categories and timeframes have been determined by Edge Plastics to be “Disqualifying Categories.”

Disqualifying Categories – 7 year “Look Back” Period from Date of Application

¹The 7 year “Look Back” does not apply to sexual offenders or sexually oriented crimes.

Edge Plastics does not currently use an outside agency to conduct its criminal background screenings, and all screenings are conducted by members of the Edge Plastics, Inc. HR staff and results are held in strict confidence.

PRINT ALL INFORMATION CLEARLY

First Name

Middle Initial

Last Name

Suffix (Jr, III, etc.)

Last for digits of your Social Security Number

List Your Addresses for the Past 7 years – minimum City and State and approximate dates

Street Address 1:

City and State:

County;

Dates:

Street Address 2:

City and State:

County;

Dates:

Street Address 3:

City and State:

County:

Dates:

Street Address 4:

City and State:

County:

Dates:

sig2

Today's Date