Leon Plastics, Inc.
4901 Clay Avenue SW
Grand Rapids, MI 49501-0350

Application for Employment

Instructions:  All fields in red and marked with "**" after them are required fields. Please fill them in using the appropriate format. Phone numbers are to be entered in the format 000-999-9999, where 000 is the area code. Dates are to be entered using the month-day-year format: mm-dd-yyyy (use dashes to separate the numbers). Please be sure to include all 4 digits in the year. In order to submit your application, you MUST read and agree to the Applicant's Statement at the bottom of the form. Incomplete Applications will not be considered.
We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Position applied for

How did you learn about us?

Last Name**

First Name**

Middle Name

Address, City, State, ZIP**

Phone Number**

 

 
Best time to contact you at home is

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Have you ever filed an application with us before?**

If Yes, give date
Have you ever been employed with us before?

If Yes, give date
Do any of your friends or relatives, other than spouse, work here?

Are you currently employed?

May we contact your present employer?

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.

Are you currently on "lay-off" status and subject to recall?

Can you travel if a job requires it?

I am available to work

Full time availability

Part time availability

Temp availability (enter dates available)

Date available for work**

What is your desired salary range?

 


Education

Name and Address of School

Course of Study

No. of Years Completed

Diploma/Degree

Elementary School

High School

Undergraduate College

Graduate Professional

Other (Specify)

Describe any specialized training, apprenticeship, skills, and extra-curricular activities. Describe any job-related training received in the United States military.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities, or other protected status.

1. Employer Dates Employed

Work Performed
Address From To

Phone Number

Job Title

Hourly Rate/Salary

Supervisor

Starting Final
Reason for Leaving
2. Employer Dates Employed

Work Performed
Address From To

Phone Number

Job Title

Hourly Rate/Salary

Supervisor

Starting Final
Reason for Leaving
3. Employer Dates Employed

Work Performed
Address From To

Phone Number

Job Title

Hourly Rate/Salary

Supervisor

Starting Final
Reason for Leaving
4. Employer Dates Employed

Work Performed
Address From To

Phone Number

Job Title

Hourly Rate/Salary

Supervisor

Starting Final
Reason for Leaving
5. Employer Dates Employed

Work Performed
Address From To

Phone Number

Job Title

Hourly Rate/Salary

Supervisor

Starting Final
Reason for Leaving
6. Employer Dates Employed

Work Performed
Address From To

Phone Number

Job Title

Hourly Rate/Salary

Supervisor

Starting Final
Reason for Leaving
List professional, trade, business or civic activities and offices held. You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status.

 
Additional Information
Other Qualifications: Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills (Check skills/equipment operated)
Terminal Spreadsheet
PC/MAC Word Processing
Typewriter Shorthand
Production/Mobile Machinery (list) Other (list)

State any additional information you feel may be helpful to us in considering your application.
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job or occupation for which you have applied? A review of the activities involved in such a job or occupation has been given.
Have you been convicted of a felony within the last five years? Conviction will not necessarily disqualify an applicant from employment**
If yes, please explain

References

Address
1. Name

Phone Number

Address
2. Name

Phone Number

Address
3. Name

Phone Number

Applicant's Statement

I certify that answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Do you agree to this statement?**