Plato Woodwork: Application

General Information

Position(s) Applied For:
Production Office Other

How Did You Learn About Us?
Advertisement Friend Walk-In Job Service Relative Other

Last Name First Name Middle Name Email

Address City State Zip Code

Telephone Number(s) Social Security Number (optional)

If no phone number is listed, how may we contact you?

Have you ever worked under another name? Yes No If Yes, what was your previous name?

Are you under 18 years of age? Yes No

Have you ever filled an application with us before? Yes No Date if Yes

Have you ever been employed with us before? Yes No Date if Yes

May we contact your present employer? Yes No Not currently employed

Are you prevented from lawfully becoming employed in this country because of VISA or Immigration Status? Yes No
(Proof of citizenship or immigration status will be required upon employment)

What schedule would you prefer to work: Full Time Part Time Temporary (summer)

Are you currently on "lay-off" status and subject to recall? Yes No

Date available to start work Salary Expectations

Education

	Name and Address of School	Course of Study	Years Completed	Diploma/Degree
High School				Yes No
Undergraduate College				Yes No
Graduate Professional				Yes No
Other (Specify)				Yes No

Security Data:

Have you been convicted or pleaded guilty to a crime or other offense? Yes No
If Yes, Please explain:

Are you currently on parole, probation, work release program, conditional release or serving a weekend sentence as a result of a conviction or guilty plea? Yes No
If Yes, Please explain:

(A conviction is not an automatic bar to employment. The type, seriousness, frequency of violations relevancy, work history,
education and other circumstances will be considered.)

References:

Please provide the names of three business references who are not related to you. If you do not have any employment related references, please list individuals who can comment on your work skills.

Name	Phone Number	Years Known and in What Capacity
1.
2.
3.

Employment Experience:

Start with the present or last job. Please include your last four employers or last seven years of work experience. Include any job-related military service assignments and volunteer activites. Please exclude organizations that indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer 1

Name		Dates Employed From To	Work Performed
Address		Salary Starting Final
Telephone Number(s)	Job Title	Supervisor
Reason For Leaving

Employer 2

Name		Dates Employed From To	Work Performed
Address		Salary Starting Final
Telephone Number(s)	Job Title	Supervisor
Reason for Leaving

Employer 3

Name		Dates Employed From To	Work Performed
Address		Salary Starting Final
Telephone Number(s)	Job Title	Supervisor
Reason for Leaving

Employer 4

Name		Dates Employed From To	Work Performed
Address		Salary Starting Final
Telephone Number(s)	Job Title	Supervisor
Reason for Leaving

Employment Experience:

Please describe any special job-related skills and qualifications acquired from employment, other education or volunteer experiences, etc. Do not include experiences which would indicate race, color, creed, religion, sex, sexual orientation, national origin, marital status, Vietnam-era status, special disabled veteran status, status with regard to public assistance, membership or activity in a local commission, disability or age.

Agreement:

Please read the following statements carefully, as they represent matters of importance to both you and Plato Woodwork in connection with this application for employment:

I understand and agree that:

The information I have provided on this application is accurate to the best of my knowledge. Any misrepresentation or deliberate omission of any fact in my application, resume or any other materials will be justification for refusal of employment, or if imployed, termination from Plato Woodwork employment.
All job offers are conditional and contingent upon the successful completion of a pre-placement substance abuse test (urinalysis) and pre-placement physical evaluation.
Prior to the commencement of any employment, I will comply with the 1986 Immigration Reform and Control Act by providing appropriate documents establishing my identity and employment authorization for Plato Woodwork's review and completing the U.S. government Employment Eligibility Verification form.
Employment at Plato Woodwork is at-will. This means that if Plato Woodwork offers employment to me and I accept the offer, they may terminate my employment at any time for any reason with or without notice. No statement to the contrary is binding on Plato Woodwork unless it is in writing and signed by an authorized Plato Woodwork executive.

I understand and agree with the above statement and certify that all information entered on this form is valid and correct.

Dealer Location

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Copyright © 1999-2006 Plato Woodwork, Inc.
Plato, MN 55370
(800) 328-5924