Employment Application

APPLICANT NOTE: This Employment Application is intended for use in evaluating your qualifications for employment. THIS APPLICATION IS NOT A CONTRACT. Please answer all questions completely (do not leave blanks) and to the best of your ability. False or misleading statements are grounds for refusal or termination of employment and benefits. It is the policy of this Company as an Equal Opportunity Employer to ensure that there shall be no discrimination against any employee or applicant for employment on the basis of race; religion; national origin; sex (including gender identity); sexual orientation; pregnancy or related medical conditions; age; disability or handicap; genetic information; citizenship status; service member status; or any other category protected by federal, state, or local law. Winona PVD will comply with its obligation to provide reasonable accommodation to qualified individuals with disabilities.

CONTACT INFORMATION

May we contact you at work?:

Are you 18 years of age or older?:

Are you legally eligible for employment in this country?
(Proof of eligibility will be required upon employment.)

Will you now or in the future require sponsorship for a visa authorizing you to work in the United States?


POSITION

Salary Expected:

What date are you available to start?

Work Availability:

Work Shifts:

Available for Overtime?

Have you ever interviewed for a position at Winona PVD?

Have you ever been previously employed by Winona PVD or through a temporary agency at Winona PVD?


Transportation to work?

If hired, are you able to provide proof of eligibility to work in the United States?

Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?


EDUCATION

(If diploma or degree was received under a different name, please include.)

High School Degree Received?

College Degree Received?

Graduate Studies Degree Received?


EMPLOYMENT HISTORY - 10 YEARS

(Please explain any gaps in your employment history - attach additional pages if needed)

Present or last employer:

May we contact for a reference?

2nd Previous Employer

3rd Previous Employer

4th Previous Employer

5th Previous Employer


APPLICANT SKILLS

.
List any skills that may be useful for the job you are seeking. Enter the number of years of experience. Ability or Skill; Years of experience.


BACKGROUND INFORMATION

When completing this section, do not disclose information regarding convictions that have been judicially sealed, expunged, eradicated, impounded or dismissed. Do not disclose information regarding juvenile court convictions or minor traffic violations. A conviction record does not automatically bar you from employment. The age, nature of the crime and its relationship to the job applied for will be considered.

1. Have you been convicted of, pled guilty or no contest to, been imprisoned, or been on probation or parole for any felony? A felony is a crime for which the punishment may result in imprisonment for more than one year.

2. Have you been convicted of, pled guilty or no contest to, been imprisoned, or been on probation or parole for any misdemeanor? A misdemeanor is a crime less serious than a felony for which the punishment may result in imprisonment for up to 1 year.

3. Are you currently on probation or parole?

If you answered "Yes" to any of the questions above, please explain completely, including dates, locations, crime/offense charged,
convicted offense and jurisdiction:


MILITARY SERVICE

(Complete if you have served in the US Military. A copy of your DD-214 may be needed for verification.)


PROFESSIONAL REFERENCES

(List individuals familiar with your work; do not include relatives.)


Upload any other documents you wish to send with your application:


I understand this application will remain on file for 90 days.

I certify that I have read and understand the "Applicant Note" on page one (1) of this document and that the answers given by me to the foregoing questions and the 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 the facts called for in this application, or other documents or information used for application of employment such as, but not limited to, a resume, may result in rejection of my application or discharge at any time during my employment, no matter when the false information, omissions or misrepresentations are discovered.

“I UNDERSTAND THAT IF I AM HIRED MY EMPLOYMENT IS AT-WILL, MEANING THAT EITHER WINONA PVD OR I MAY TERMINATE THE EMPLOYMENT AT ANY TIME, WITHOUT NOTICE, AND FOR ANY REASON. THIS AT-WILL STATUS MAY BE CHANGED ONLY BY A WRITTEN STATEMENT, SIGNED BY THE CHAIRPERSON OF THE BOARD, WHICH SPECIFICALLY IDENTIFIES THE MANNER IN WHICH THE AT-WILL RELATIONSHIP HAS BEEN ALTERED. NO OTHER PRIOR OR SUBSEQUENT ORAL OR WRITTEN ASSURANCES, REPRESENTATIONS, HANDBOOKS, NOTICES, OR POLICY MANUALS WILL OPERATE TO ALTER THIS RELATIONSHIP. I FURTHER UNDERSTAND THAT THE INITIAL SALARY AND OTHER TERMS AND CONDITIONS OF MY EMPLOYMENT, AS WELL AS ALL COMPANY POLICIES, PRACTICES, PROCEDURES, AND STANDARDS, MAY BE CHANGED OR ELIMINATED BY WINONA PVD COATINGS, LLC AT ANY TIME.”

I authorize Winona PVD Coatings, LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

I authorize Winona PVD Coatings, LLC to conduct any legal, personal, criminal or credit background check relating to me as Winona PVD Coatings, LLC deems appropriate, subject to applicable laws and regulations. I further acknowledge and agree that any offer of employment made by Winona PVD Coatings, LLC or any employment relationship that may be created between me and Winona PVD Coatings, LLC is subject to my completion of and the results of any required pre-employment drug screen, legal, personal, criminal and/or credit background check relating to me, including the satisfactory results of any of the foregoing as determined by Winona PVD Coatings, LLC in its sole and absolute discretion.

In accordance with Winona PVD Coatings, LLC policy to maintain a drug-free workplace, I understand any offer of employment will be contingent upon my submitting to a drug test and receiving a negative test result. I understand certain employees may be subject to drug testing throughout their employment. I hereby agree to drug testing as required by Winona PVD Coatings, LLC policy and release Winona PVD Coatings, LLC from all liability arising from such testing and/or the decisions made based on such testing.

I also agree that employment is contingent upon meeting the requirements of all government immigration control regulations.

Checking this box indicates you agree to all of the above terms and conditions.

Winona PVD Coatings, LLC

1180 Polk Drive

Warsaw, IN  46582


Phone:

574-269-3255


Fax:

574-269-3855