Application for Employment PERSONAL DATAName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Phone*Alternate PhoneU.S. Citizen Yes No If no, give current Visa status REFERRALHow did you hear about Lehigh Valley Plastics? Were you referred by someone? Yes No If yes, by whom? JOB INTERESTPosition Desired* Have you worked for us before? Yes No Are you available to work overtime if necessary? Yes No Available for: 1st Shift 2nd Shift 3rd Shift Weekends EDUCATION AND TRAININGHigh School Name and Location College/Business/Trade/Technical Name and Location College/Business/Trade/Technical Courses Taken Comments/AdditionalHave you ever worked with any of the following, either on the job or as part of a hobby: (check all that apply) Tape Measure Dial Caliper Micrometer Height Gauge Depth Gauge Computers Have you ever read blueprints or worked from a pattern? Yes No What is the smallest increment on a ruler that you can read? EMPLOYMENT EXPERIENCEList past employment record as completely as possible, beginning with the most recent employer (Include US Military Service)First Company Name & Address First Company Dates of employment First Company Salary First Company Position & Responsibilities First Company Reason for Leaving Second Company Name & Address Second Company Dates of Employment Second Company Salary Second Company Position & Responsibilities Second Company Reason for Leaving Have you been convicted of a felony in the last seven years?* Yes No If yes, give date(s) Where was your conviction? Nature of Crime(s) READ CAREFULLY BEFORE SUBMITTING By submitting this form, you are confirming that: 1. The information I have furnished on this application form is true and complete. I understand that any offer of employment made to me may be withdrawn or my subsequent employment with the Company may be terminated if any misrepresentation has been made by me. 2. If I am not a US Citizen, I hereby certify to Lehigh Valley Plastics, Inc. that my presence and employment in the United States has been legally authorized by the US Immigration and Naturalization Service and that I will maintain my legal or non-immigrant status. Upon employment, I will produce required documents that establish my employment authorization and identity. 3. I hereby give Lehigh Valley Plastics, Inc. the right to investigate my background and release from all liabilities all persons or corporations supplying information. As part of the normal procedure for processing applications, a routine inquiry made be made on my reputation, background, and personal characteristics. Disclosure of the nature and scope of this investigation is available upon written request. 4. I understand that any offer or acceptance of employment does not constitute a binding contract and such employment is terminable at the will of either party.
