Highlight Industries Application for Employment

Highlight Industries is an Equal Opportunity Employer

Please PRINT.

Position applied for: ____________________________________________________________

Date of application: _____/______/_____

Name: ______________________________________________________________________
                     LAST                                                        FIRST                                                           MIDDLE

Address: ____________________________________________________________________
                     STREET                                                    CITY                                                            STATE             ZIP CODE

Social Security Number: _____________________________________

Telephone Number: ________________________________________

E-Mail Address: ___________________________________________

Driver's License Number (if driving is an essential job function):
_________________________________     State: ___________

EMPLOYMENT HISTORY
Provide the following information of your past and current employers, starting with the most recent (use additional sheets if necessary). Explain any gaps in employment in Comments section.

Employer: ___________________________________________________________________
Telephone Number: ___________________________________
Address: ____________________________________________________________________
Dates Employed: from___________________________ to _________________________
Hourly Rate / Salary: starting $_______________ per _____________
Hourly Rate / Salary: final $_______________ per _____________
Starting Job Title / Final Job Title: _________________________________________________
Immediate Supervisor and Title: ___________________________________________________
Summarize the type of work performed and job responsibilities: ___________________________
___________________________________________________________________________
___________________________________________________________________________
Reason for leaving: ____________________________________________________________
May we contact for reference? (circle one):   Yes     No     Later

Employer: ___________________________________________________________________
Telephone Number: ___________________________________
Address: ____________________________________________________________________
Dates Employed: from___________________________ to _________________________
Hourly Rate / Salary: starting $_______________ per _____________
Hourly Rate / Salary: final $_______________ per _____________
Starting Job Title / Final Job Title: _________________________________________________
Immediate Supervisor and Title: ___________________________________________________
Summarize the type of work performed and job responsibilities: ___________________________
___________________________________________________________________________
___________________________________________________________________________
Reason for leaving: ____________________________________________________________
May we contact for reference? (circle one):   Yes     No     Later

Employer: ___________________________________________________________________
Telephone Number: ___________________________________
Address: ____________________________________________________________________
Dates Employed: from___________________________ to _________________________
Hourly Rate / Salary: starting $_______________ per _____________
Hourly Rate / Salary: final $_______________ per _____________
Starting Job Title / Final Job Title: _________________________________________________
Immediate Supervisor and Title: ___________________________________________________
Summarize the type of work performed and job responsibilities: ___________________________
___________________________________________________________________________
___________________________________________________________________________
Reason for leaving: ____________________________________________________________
May we contact for reference? (circle one):   Yes     No     Later

Employer: ___________________________________________________________________
Telephone Number: ___________________________________
Address: ____________________________________________________________________
Dates Employed: from___________________________ to _________________________
Hourly Rate / Salary: starting $_______________ per _____________
Hourly Rate / Salary: final $_______________ per _____________
Starting Job Title / Final Job Title: _________________________________________________
Immediate Supervisor and Title: ___________________________________________________
Summarize the type of work performed and job responsibilities: ___________________________
___________________________________________________________________________
___________________________________________________________________________
Reason for leaving: ____________________________________________________________
May we contact for reference? (circle one):   Yes     No     Later

Comments (including explanation of any gaps in employment): __________________________
___________________________________________________________________________
___________________________________________________________________________

SKILLS AND QUALIFICATIONS
Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

EDUCATIONAL BACKGROUND
List last three (3) schools attended, starting with the most recent; provide number of years completed; indicate degree or diploma earned, if any.

School: _____________________________________________________________________
Number of years completed: _______________
Degree/Diploma: ________________________

School: _____________________________________________________________________
Number of years completed: _______________
Degree/Diploma: ________________________

School: _____________________________________________________________________
Number of years completed: _______________
Degree/Diploma: ________________________

REFERENCES
List name and telephone number of three (3) business/work references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Name: ___________________________________________________
Telephone: (_____) ______________________
Number of years known: ____________

Name: ___________________________________________________
Telephone: (_____) ______________________
Number of years known: ____________

Name: ___________________________________________________
Telephone: (_____) ______________________
Number of years known: ____________

ADDITIONAL INFORMATION
List professional, trade, business or civic associations and any offices held. Exclude memberships that would reveal race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve National Guard or any other similarly protected status.

Organization: _________________________________________________________________
Offices held: _________________________________________________________________

Organization: _________________________________________________________________
Offices held: _________________________________________________________________

Organization: _________________________________________________________________
Offices held: _________________________________________________________________

Organization: _________________________________________________________________
Offices held: _________________________________________________________________

GENERAL INFORMATION

If necessary, best time to call you at home is ____________ (circle one)  A.M.   P.M.

May we contact you at work? (circle one)   Yes     No

If yes, work number and best time to call: _____________________  ________ (circle one) A.M.   P.M.

If you are under 18 and it is required, can you furnish a work permit? (circle one)   Yes     No

If no, please explain: ___________________________________________________________

Have you ever been employed here before? (circle one)   Yes     No

If yes, give dates:  from ____/____/____ to ____/____/____

Are you legally eligible for employment in this country? (circle one)   Yes     No

Date available for work:  ____/____/____

What is your desired salary range?  $________________

Type of employment desired (circle any that apply):
       Full-time      Part-time        Temporary         Seasonal         Educational Co-op

Will you relocate if job requires it? (circle one)   Yes     No

Will you travel if job requires it? (circle one)   Yes     No

Are you able to meet the attendance requirements of the position? (circle one)   Yes     No

Have you ever been bonded? (circle one)   Yes     No

Have you ever pled "guilty" or "no contest" to, or been convicted of a crime? (circle one)   Yes     No

If yes, please provide date(s) and details: ____________________________________________
___________________________________________________________________________
Answering "Yes" to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

APPLICANT STATEMENT

1. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
2. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
3. I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
4. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.
5. I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.
6. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer's service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Signature of Applicant: _______________________________________________________

Date: ______/______/______