SECTION 1 - EMPLOYMENT ELIGIBILITY

Have you been convicted of a serious crime/felony in the past seven years? Yes NoConviction of a crime is not an automatic bar of employment. All circumstances will be considered including the nature and seriousness of the crime and all rehabilitation efforts made by the applicant.

Social Security Number:

MI: Last Name:

City: State: Zip:

Date of Application:

First Name:

Address:

Primary Phone Number:

Email Address:

________ _________

EMPLOYMENT APPLICATION

Secondary Phone Number:

Please answer the following questions to determine your eligibility for employment with ERMCO. Select all positions for which you are applying:

Production Machine Operator

Shipping/Receiving

Are you at least 18 years of age? Yes No

Have you previously worked at ERMCO? Yes No

Are you available to work full time? Yes No

What is your shift availability? Any 1st 2nd 3rd

Are you willing to work overtime? Yes No

If you have worked at ERMCO through a staffing service, please provide agency name:

If you are a former full time ERMCO employee, please provide your reason for leaving employment:

Please provide additional information about your former employment with ERMCO:

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Coil Winder Quality Office

Welding (EXP REQ) Maintenance (EXP REQ)

SECTION 2 - EDUCATION

High School Diploma: Yes No

State:

Yes No

Name of High School: City:

If you answered "no" to the above question, did you receive your GED?

From where did you obtain your GED?

School Name 2:

Graduated: Yes No

School Type: Technical/Vocational

City:

Course of Study: Degree Earned:

School Name 3: City: State:

Graduated: Yes No Years Attended: to

School Type: Technical/Vocational College/University

Course of Study: Degree Earned:

SECTION 3 - Military Service

Yes No If "yes" what branch?

Rank at Discharge:

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Were you in the U.S. Armed Services?

Years of duty: to

List your job duties while in the service:

List any honors, medals, achievements:

State:

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Years Attended: to

Name of Previous Employer 2:

City: State:

Dates of Employment: to

Are you still employed? Yes No

State:

to

Reason for Leaving:

What was your overall experience with this employer/what did you like best/least?

SECTION 4 - WORK EXPERIENCE

Name of Current or Last Employer:

City:

Job Type: Job Title:

Supervisor's Name: Supervisor's Job Title:

May we contact employer for reference: Yes No If "no", why?

Provide a brief description of your job duties and any specialized skills you learned and used:

Job Type:

Supervisor's Name:

May we contact employer for reference: Yes

Job Title:

Supervisor's Job Title:

No If "no", why?

Provide a brief description of your job duties and any specialized skills you learned and used:

Start Month/Year End Month/Year

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Employer Phone #:

Zip: Ending Pay Rate:

Dates of Employment:

Zip:

Employer Phone #:

Ending Pay Rate:

Start Month/Year End Month/Year

Reason for Leaving:

What was your overall experience with this employer/what did you like best/least?

SECTION 4 - WORK EXPERIENCE

State: Zip:

Name of Previous Employer 3:

City:

Dates of Employment: to

Job Type: Job Title:

Supervisor's Name: Supervisor's Job Title:

May we contact employer for reference: Yes No If "no", why?

Provide a brief description of your job duties and any specialized skills you learned and used:

Job Type:

Supervisor's Name:

May we contact employer for reference: Yes

Job Title:

Supervisor's Job Title:

No If "no", why?

Provide a brief description of your job duties and any specialized skills you learned and used:

Name of Previous Employer 4:

City: State: Zip:

Dates of Employment: to

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Ending Pay Rate:

Employer Phone #:

Start Month/Year End Month/Year

Reason for Leaving:

What was your overall experience with this employer/what did you like best/least?

Employer Phone #:

Ending Pay Rate:

Start Month/Year End Month/Year

Reason for Leaving:

What was your overall experience with this employer/what did you like best/least?

Please select the skills you gained from current/prior work experience.

Machines / Equipment / Tools Operated during your past employment:

SECTION 5 - TECHNICAL SKILLS & EQUIPMENT KNOWLEDGE

Amada

Band Cutter

Band Saw

Banding Gun

Bell Oven

Brake Press

CNC

Coil Press

Conveyor

Stencil Machine

Table Crimper

Turret Press

Vacuum Pump

Walk Behind Jack

Wash Booth

Wire Crimpers

Wire Stripper

Overhead Crane

Paint Booth

Paper Slitter

Platform Scales

Press

Punch Press

Scan Gun

Standup Forklift

Cooling Tunnel

Crane

Die Form

Digital Test Meters

Drill Press

Forklift

Hoist

Lead Cutter

Hand Tools

Select the the hand tools you were trained to use during your past employment and provide years of experience.

Battery YRS Electric YRS Impact YRS Pneumatic YRS

How would you describe your experience? Beginner I Intermediate Advanced

Where were you trained to operate hand tools? Describe your job. (Employer, Job Duties, etc.)

Blueprints YRS

Carpentry YRS

Electrical YRS

Farming YRS

HVAC YRS

Maintenance YRS

Shipping YRS

YRS

YRS

YRS

YRS

YRS

YRS

Mechanical

Production

Quality

Fast Paced Assembly

Slow Paced Assembly

Electrostatic Painting

Receiving YRS

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Select the types of welding you have performed during your past employment and provide years of experience.

Select the skills you received, either in training or during your employment:

Where were you trained to weld? Describe your job. (Employer, Job Duties, etc.)

MIG YRS TIG YRS ROBOT YRS

How would you describe your welding experience? Beginner Intermediate Advanced

Please list any significant mechanical or craft experience from either jobs or hobbies.

Please provide additional comments regarding your qualifications.

I certify the information contained in this application is correct and understand that falsification of information provided prior to employment, or anytime thereafter, is grounds for dismissal, regardlessof when such falsification is discovered.

If employed, I understand that I will be a probationary employee for 90 days, during which time either ERMCO or myself may terminate the employment without prior warning or notice. I further acknowledge that if I am employed by ERMCO, my employment is subject to termination with or without cause, at any time, by either ERMCO or me.

If I am hired, I agree to comply with the rules and policies of the company, including any changes that may be made from time to time. I also agree to abide by the laws and regulations of any authorized government or government agency pertaining to my employment. Employment with ERMCO is for no definite term, and may be terminated at any time by either the Company or myself.

I understand that no agent or representative of ERMCO, except the President, has any authority to make any express or implied agreement to the foregoing. Any agreement by the president must be in writing.

I consent to take a pre-employment drug test and such future drug or alcohol tests as may be required. I understand that any offer of employment given to me is contingent upon a negative result on my pre-employment drug screening. I also understand that ERMCO absolutely prohibits illegal drug use both on and off the job, since off the job use may affect my job performance and safety, and that illegal use at any time may result in immediate termination of employment.

I authorize any of the persons, previous employers, or educational institutions named in this application to release to ERMCO any and all information they may have concerning me, including records of disciplinary action and reasons for termination of employment. I release all such parties from liability which may result from furnishing such information. A photocopy of this authorization shall be my authorization for release of information.

Do you agree to the above statements? Yes No

Applicant’s Signature:

Date Agreement Was Signed:

APPLICATIONS ARE KEPT ON ACTIVE FILE FOR SIX MONTHS.

SECTION 6 - APPLICATION CERTIFICATION

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