Application for Employment
    An Equal Oportunity Employer
Instructions: All fields in red 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). 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(s) Applying for Date of Application (mm-dd-yyyy)
How did you hear about this position? Employee Referral
Type of work applying for  
 
First Name Middle Name Last Name    
 
Present Addresss City State Zip Code
Permanent Address City State Zip Code
Telephone Number(s) (xxx-xxx-xxxx) Home Alternate  
   
What is the best time to contact you at home?
Shift Availability
Are you 18 years of age or older?
Are you authorized to work in the United States?
Proof of citizenship or immigration status will be required upon employment.
Have you ever been convicted of a felony?
A criminal record does not constitute an automatic bar to employment and will be considered only as it relates to the job in question.
Are you currently employed?
Are you on "layoff" status or subject to recall?
Are you available to work daily and weekend overtime when required?
Do you have reliable transportation to and from work?
Date available for work: (mm-dd-yyyy)  
What is your desired salary range?  
Have you ever filed an application with Leon Plastics?
If yes, when?  
Have you ever been employed by Leon Plastics?
If yes, when?  
What was the reason for leaving?
  Name and Address of School Did you Graduate? Course of Study/Degree Received/Certifications
High School
 
College
 
Trade or Technical School
 
Trade or Technical School
 
Other
(Specify)
 
Describe any specialized training, apprenticeship, skills, and extra-curricular activities
Summarize special job-related skills and qualifications acquired from employment or other experience. Please indicate machinery operated (ex. Injection Mold Press).
State any additional information you feel may be helpful to us in considering your application.
List below the names of four persons who have direct knowledge of you skills, experience, and background for the position for which you are applying.
Full Name Business or Home Address Occupation Telephone Number
Please complete the following section beginning with your present or most recent employment. Please account for all time, including current employment, military service, part-time jobs,and periods of unemployment.
Employer Dates Employed Job Responsibilities/Work Performed
From To
Address
Hourly Rate/Salary
Telephone Number(s) Starting Final
Job Title Supervisor
Reason for Leaving Total numbers of hours worked weekly
Employer Dates Employed Job Responsibilities/Work Performed
From To
Address
Hourly Rate/Salary
Telephone Number(s) Starting Final
Job Title Supervisor
Reason for Leaving Total numbers of hours worked weekly
Employer Dates Employed Job Responsibilities/Work Performed
From To
Address
Hourly Rate/Salary
Telephone Number(s) Starting Final
Job Title Supervisor
Reason for Leaving Total numbers of hours worked weekly
Employer Dates Employed Job Responsibilities/Work Performed
From To
Address
Hourly Rate/Salary
Telephone Number(s) Starting Final
Job Title Supervisor
Reason for Leaving Total numbers of hours worked weekly

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 the essential functions of the job for which you are applying, with or without reasonable accommodations? A list of the essential functions of each job is available by contacting the Human Resources Department.

I confirm that the information provided on this Application (and accompnaying resume, if any) is true and complete. I understand that any false information, misrepresentations, or omissions will disqualify me from futher consideration for employment, and will result in termination of my employment if disovered after I am hired.

I understand that this application will remain active for a period of 60 days from the date it is submitted to the Company, and that if I wish to be considered for a position after that period of time, I must complete and submit a new application form.

I authorize a complete investigation of all statements and references contained in this application adn of my education and employment history, including transcripts of grades, verification of degrees conferred, personnel and dscipline records, and agree to cooperate in such investigation. I release from all liability and responsibility all persons, educational institutions, and employers requesting or supplying such information, and waive any right to notice of disclosure of such information. I aslo authorize my prior employers and educational institutions to release to and discuss with the Company any information about my education or employment, including disciplinary history and reports, and waive the right to receive written notice of such disclosure.

I give my consent for the Company, through an authorized testing service of its choice, to collect blood, urine, or other samples from me to conduct any other necessary tests to determine the presence of alcohol, drugs, or controlled substances. I release the Company from any liability arising out of such test or its results. Further, I give my consent for the testing facility to release to and disuss with the Company the results of the tests. If I am accepted for employment by the Company, I consent to be tested in the above manner during my employment when, in the Company's sole judgment, such testing is appropriate. I acknowledge that remaining free of illegal drug use and complying with Company's substance abuse policy is a condition of my employment.

I understand that my employment will be on an at will basis. The means taht either I or the Company may terminate the employment relationship at any time, for any reason, with or without cause, and with or without prior notice, warning, or discipline. I understand that no person other than the President of the Company has authority to offer employment for any specified period or to enter into any contract of employment. Moreover, no such agreement by will be enforceable unless it is in writing, pertains specifically to me, and is signed by the President fo the Company.
Do you agree with the above statement? Signature of Applicant Date