Online Application Form | Dakota Molding

Name*

First Middle Last

Current Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Cell Phone*

Ever worked for this company before?*

If so, when

Are you 18 years or older?*

Yes
No

Are you legally eligible for employment in the United States?*

Yes
No

Are you able to perform the essential functions of the job with or without reasonable acommodation?

EMPLOYMENT DESIRED

Position Applying for:*

Date available to start:*

Salary Desired*

Are you willing to work any shift, including nights & weekends?*

Yes, able.
No, not able.

If no, please state limitations

Were you referred by anyone? If yes, list name.

EDUCATION AND TRAINING

High School name and address

Last Grade Completed:

Years Attended

Diploma?

Yes
No

College name and address

Did you receive a degree?

Yes
No

If yes, degree received

Years Attended

Other training/certification:

PREVIOUS EMPLOYMENT HISTORY

Company Name*

Address*

Street Address City State ZIP Code

Position and Duties*

Reason for Leaving*

Start and end date*

Ending Wage*

Company Name

Address

Street Address City State ZIP Code

Position and Duties

Reason for Leaving

Start and end date

Ending Wage

Company Name

Address

Street Address City State ZIP Code

Position and Duties

Reason for Leaving

Start and end date

Ending Wage

Disclaimer:

***DISCLAIMER*** By Agreeing and Submitting this form, I certify that the information provided is truthful and accurate. I understand that providing false or misleading information will be basis for rejection of my application, or if employment commemces, immediate termination of employment. Any offer of employment I may receive from Dakota Molding is contingent upon my successful completion of the firms pre-employment review process including the firm's receiving references that it considers satisfactory. I understand that in processing of my application for employment, the firm may verify all information provided by me including but not limited to, my prior employment, military record, education, character, general reputation, personal characteristics and criminal record. I authorize any person, school, current or prior employer named in this form (or related document or interview) to provide the firm with any information an opinion requested by Dakota Molding in connection with my application, and I release such person's employers, and schools from any liability in making statements. In consideration of my employment, I agree to comform to the company's rules and regulations, and I agree that my employment and compensation is At-Will and can be terminated at any time, with or without cause and with or without notice, at any time by the company. I understand that no companyrepresentative, other that its President, and the only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing. I certify that all the information submitted by me on this aplication is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed may be terminated at any time.*

I Agree

Todays Date:*

Engineering Technician

EMPLOYMENT DESIRED

EDUCATION AND TRAINING

PREVIOUS EMPLOYMENT HISTORY

Disclaimer: