"*" indicates required fields Position InformationApplying for Position:*Date:* Referral Source: Advertisement Friend Relative Walk-In Other Other Referral Source:Personal InformationName:*Address:*Phone:*Email:* General Information1. Are you under 18 and able to provide proof of eligibility to work?* Yes No 2. Have you applied here before?* Yes No If yes, what date? 3. Employment Desired:* Full-Time Part-Time 4. Are you currently employed?* Yes No 5. May we contact your current employer?* Yes No 6. Are you legally authorized to work in the United States?* Yes No 7. Available start date: 8. Are you on layoff and subject to recall? Yes No 9. Are you familiar with the responsibilities of this role?* Yes No 10. Have you been convicted of a felony within the past 7 years?* Yes No 11. Do you have any relatives or friends employed here?* Yes No If yes, who?Employer Contract Preferences13. Do you own glazing tools?* Yes No 14. Can you read a tape measure accurately?* Yes No 12. Have you completed an apprenticeship?* Yes No Trade:Length:Location:Essential Job FunctionsCan you perform the following tasks with or without reasonable accommodation? Check every “yes”.* Stand and remain on your feet for extended periods Lift and carry materials up to 100 lbs Work in varying positions, including bending, climbing, and confined spaces Operate tools, machinery, and work-related equipment safely Work outdoors in varying weather conditions and environments None of the above Accomodations Requested:Employment HistoryCompany Name:Address:Phone:Email: Employment Dates:From: To: Starting Pay:Ending Pay:SupervisorJob Title & Duties:Reason for Leaving:Company 2 Name:Company 2 Address:Company 2 Phone:Company 2 Email: Employment Dates:Company 2 From: Company 2 To: Company 2 Starting Pay:Company 2 Ending Pay:Company 2 SupervisorCompany 2 Job Title & Duties:Company 2 Reason for Leaving:Company 3 Name:Company 3 Address:Company 3 Phone:Company 3 Email: Employment Dates:Company 3 From: Company 3 To: Company 3 Starting Pay:Company 3 Ending Pay:Company 3 SupervisorCompany 3 Job Title & Duties:Company 3 Reason for Leaving:Skills & Trade ExpertiseYou may contact all employers* Yes No Do NOT contact:Driving RecordThis position may require driving a company vehicle.Valid driver's license?* Yes No Any accidents or moving violations in the past 5 years?* Yes No Please explain:EducationHigh School Name:*Location*Completion: Diploma GED Did Not Graduate Additional Education (if applicable)Additional Information (special skills, training or certifications)Honors or Awards:References (please list 3 non-relatives)Ref 1 Name:Ref 1 Phone:Ref 1 Email: Ref 2 Name:Ref 2 Phone:Ref 2 Email: Ref 3 Name:Ref 3 Phone:Ref 3 Email: Equal Opportunity Statement Allied Glass is an equal opportunity employer and considers applicants without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, veteran status, or any other protected status under applicable law. ________________________________________ Pre-Employment Screening & Applicant Acknowledgment Employment is contingent upon successful completion of a pre-employment drug screening. By submitting this application, I certify that the information provided in this application is true and complete to the best of my knowledge.
