Medical Device Pad Printing - Employment Application

Position Applied For:*

Salary Expectations:*

Please specify year or hourly

Date:

Personal Data

Only applicants 18 years or older may apply for positions at this company.

Name:*

First Name Last Name

Address:

Country*

Address Line 1*

Address Line 2

City*

State*

ZIP Code*

Email:*

Phone:*

Preferred Method of Correspondence:

Phone

Are there any days, shifts or hours you will not work?

Yes

If yes, please explain:

Are you available for out of town work?

Yes

Will you work overtime, if required?

Yes

When will you be able to start work?

How did you learn of our company?

If referral, who were you referred by?

Have you ever applied or worked at our company before?

Yes

If yes, provide dates:

Are you legally authorized to work in the United States?

Yes

Will you now or in the future require sponsorship for employment visa status (e.g.,H-1B visa status)?

Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.

Yes

Driving Record

Answer only if driving is a requirement of the job for which you are applying

Do you have a valid driver's license?

Yes

Have you had any tickets?

Yes

If yes, please explain:

Education

Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:

High School:

Graduated?

Yes

If no, degree credits earned?

Type of degree received or expected:

Grade Point/Overall GPA:

College or University:

Graduated?

Yes

If no, degree credits earned?

Type of degree received or expected:

Major/Minor:

Grade Point/Overall GPA:

Technical/GED:

Graduated?

Yes

If no, degree credits earned?

Type of degree received or expected:

Major/Minor:

Grade Point/Overall GPA:

Employment History

Please complete for all full-time or part-time employment beginning with most recent employer. You may include as part of your employment history any verified work performed on a volunteer basis. All applicants should start with their most recent job, include active military assignments and voluntary employment and provide ten (10) years of history. (A separate sheet may be attached at end of application.) You must explain any gaps in your employment history.

Company Name:

Phone:

Address:

Name of Supervisor:

May we contact?

Yes

Rate of Pay:

Please provide starting and ending pay rate.

Job title(s) and describe job duties:

Reason for leaving:

Company Name:

Phone:

Address:

Name of Supervisor:

May we contact?

Yes

Rate of Pay:

Please provide starting and ending pay rate.

Job title(s) and describe job duties:

Reason for leaving:

Company Name:

Phone:

Address:

Name of Supervisor:

May we contact?

Yes

Rate of Pay:

Please provide starting and ending pay rate.

Job title (s) and describe job duties:

Reason for leaving:

Company Name:

Phone:

Address:

Name of Supervisor:

May we contact?

Yes

Rate of Pay:

Please provide starting and ending pay rate.

Job title (s) and describe job duties:

Reason for leaving:

Please explain any gaps in your employment history:

Have you ever been discharged or forced to resign?

Yes

If yes, explain:

Did you receive any discipline in your last 12 months of active employment?

Yes

If yes, explain:

Were you given a performance evaluation within the last 12 months of active employment?

Yes

If yes, what was the range of scores used and what was your score?

Have you signed any non-solicitation agreement with any other employer that might restrict you from working for this company?

Yes

(You many be required to furnish a copy of the agreement.)

If yes, please explain:

References

Please list three persons not related to you who know your qualifications

Name

First Last

Phone:

Address:

Relationship:

Name

First Last

Phone:

Address:

Relationship:

Name

First Last

Phone:

Address:

Relationship:

Military

Complete only if you served in the military

Branch of Service:

Number of Years/Month of Service:

Rank and Date of Discharge:

Reason for leaving:

Describe any military skills, training or experience you believe are relevant to the job you are applying for:

Applicant's E-Signature:*

Date:*

APPLICANT'S ACKNOWLEDGMENT

I certify that the answers given herein (including but not limited to the Commercial Motor Vehicle Driver Supplement if applicable) are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document may be cause for my dismissal at any time without prior notice.

I consent to and authorize this Company to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references to give the Company (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party(ies) for providing a good faith reference.

I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR MY EMPLOYER WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING THE BASIC EMPLOYMENT POLICIES, PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTE AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE EMPLOYER. I ALSO UNDERSTAND THAT THIS ASPECT OF MY EMPLOYMENT MAY NOT CHANGE ABSENT AN INDIVIDUAL WRITTEN AGREEMENT SIGNED BY BOTH ME AND THE PRESIDENT OF THE COMPANY.

I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver’s examination; submit to a background investigation or take a pre-employment drug test. If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all required tests. I authorize the release of any background check results and of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document.

Minnesota is an “at-will” State and Universalpromo,Inc is an “at-will” employer, meaning that employment has no specified term and that the employment relationship may be terminated any time at the will of either party.

APPLICANT'S E-SIGNATURE*

Date:*

You can upload any additional files (resume, portfolio, additional work history, etc.) you want to submit to be considered for this position. Please contact hr@universalpromo.com if you have any issue submitting this form.

HR Department sent you this request*

Resumes and Portfolios

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Employment Application

Personal Data

Driving Record

Education

Employment History

References

Military

OR CALL US AT (888) 647-6479

OR CALL US AT
(888) 647-6479