APPLICATION FOR EMPLOYMENT
South Dakota 605-356-2756 Fax: 605-356-3246
Indiana
574-295-1214 Fax: 574-295-2232
Email: hr@thermobond.com
DATE: _________________
Personal Information:
Last Name
First Name
Middle Name
Address
City, State
Zip
Home Phone
Cell Phone
Email Address
Position Applying for:
Are you applying for full or
part-time work?
How did you hear about the position?
Full time
Part time
Do you have any relatives employed
here?
Yes
No
Please list the name(s) of relatives:
If hired, how soon are you available for work?
If hired, do you have a reliable means of transportation to work?
_______Yes
_______ No
Have you ever been convicted of a felony?
______ Yes
_______ No
If yes, please explain.
Are you over the age of 18
years?
______ Yes ______ No
Are you legally eligible to work in the
US?
______ Yes ______ No
Are you currently employed?
______ Yes
______ No
If yes, may we contact your present employer for a
reference?
______ Yes
______ No
* PLEASE TURN THE PAGE TO CONTINUE WITH THE APPLICATION
1
Education:
High School
City and State
Number of Yrs Completed
Course Study
Diploma/ Degree
GPA
College
City and State
Number of Yrs Completed
Course Study
Diploma/ Degree
GPA
Trade School
City and State
Number of Yrs Completed
Course Study
Diploma/ Degree
GPA
Graduate /Other
City and State
Number of Yrs Completed
Course Study
Diploma/ Degree
GPA
Please list/ describe any specialized training, foreign languages, certifications, licenses or skills.
PREVIOUS WORK EXPERIENCE:
(Include any paid, unpaid or military service. List your most recent employers first.)
1. Start Date
End Date
Ending Pay
Name of Company
Phone Number (
Address
Job Duties
City
Supervisor
2. Start Date
State
Supervisor
)
Zip _______
Reason for leaving
End Date
Ending Pay
Name of Company
Address
Job Duties
per Hour/per Year
per Hour/per Year
Phone Number (
City
State
)
Zip
____
Reason for leaving _______________________________
2
3. Start Date
End Date
Ending Pay
Name of Company
per Hour/per Year
Phone Number (
Address
Job Duties
City
Supervisor
State
)
Zip
____
Reason for leaving _______________________________
References:
(Please list three people, who are not related to you, who can provide a professional reference.)
Name
Address
Phone Number
Relationship/Occupation
Years Known
State any additional information you feel may be helpful to us in considering your application.
Applicant Acknowledgement and Authorization
*Please read before signing
I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is
correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of
any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the
timing or circumstances of discovery. I hereby authorize my former employers, educational institutions and references to furnish
any information concerning my application for employment. I further authorize Thermo Bond to contact my former employers,
educational institutions and references for the purpose of obtaining such information. I understand that my employment can be
terminated at any time and for any reason by me or by Thermo Bond, oral representations to the contrary notwithstanding. I agree,
as a condition of hire, to provide documents establishing proof of identity and employment eligibility in compliance with the
Immigration Reform and Control Act of 1986. I understand that an offer of employment may be contingent upon passing a
company physical that includes a drug and alcohol screen. As a condition of continued employment, I may be required to submit to
a company physical that includes a screen for drugs and alcohol. By signing below I acknowledge that I have read, understood and
agree to the above statements.
SIGNATURE____________________________________________________ DATE ___________________
AN EQUAL OPPORTUNITY EMPLOYER
*Office Use Only*
PLEASE DO NOT WRITE BELOW THIS LINE
Interviewed By:
Interview Date:
Comments:
____________________________________________________________________________________________________________
________________________________________________________________________________________________________
Thermo Bond Buildings
3
DISCLOSURE OF INTENT TO OBTAIN CONSUMER REPORTS
OR INVESTIGATIVE CONSUMER REPORTS
For employment purposes, COMPANY and/or Employment Background Solutions, LLC may obtain consumer reports, or investigative
consumer reports, in connection with your employment application or from time to time during employment in accordance with
applicable law. Consumer reports include record checks conducted by consumer reporting agencies and may include driving
records, criminal records, credit records, etc. Investigative consumer reports include investigations (for example, reference checks)
conducted by consumer reporting agencies through personal interviews (or through any means in California) on information as to
character, general reputation, personal characteristics, or mode of living. You may make a written request for a summary of
consumer rights and a disclosure of the nature and scope of an investigation. A disclosure of the nature and scope of such
investigation is provided below.
DISCLOSURE OF NATURE AND SCOPE OF INVESTIGATION
FOR INVESTIGATIVE CONSUMER REPORT
In the event we request an investigative consumer report in connection with your employment application, a consumer reporting
agency will prepare an investigative consumer report based on the following investigation: The agency will interview your former
employers, business references, and/or personal references for information regarding prior employment, work experience and
performance, reasons for employment termination, and information as to character, general reputation, personal characteristics, or
mode of living. The agency will also conduct a records check of driving, criminal, credit, education, degrees, professional licenses,
and/ or certification records depending on the position. Such a report, as well as any credit report, will be obtained from
Employment Background Solutions, LLC. I have received a summary of my rights under the Fair Credit Reporting Act.
AUTHORIZATION
I authorize COMPANY and the Employment Background Solutions, LLC, to obtain consumer reports and/or investigative consumer
reports regarding me from time to time for employment purposes. In compliance with the Fair Credit Reporting Act, as amended by
the Consumer Credit Reporting Reform Act of 2003, Employment Background Solutions, LLC,. needs my authorization to obtain such
a report.
*This information will not be used for the purpose of discrimination. The Federal “Age Discrimination in Employment Act” of 1967
prohibits discrimination on the basis of age.
Signature:
Date:
Print Name:
Date of Birth:
___
Address:
Social Security #:
___
City
State ___________________ Zip______________
4
___