Employment Application

Please complete the following form to submit your application online, or click the button below to download our application form as a PDF which can be printed, filled out by hand and mailed or faxed to our headquarters.

Position(s) applied for
Date of application
Referral Source
Name of source (if applicable)
First Name
Middle Name
Last Name
Address
City
State
Zip Code
Telephone number
Social Security number
If necessary, best time to call you at home is
May we contact you at work? Yes   No
If yes, work number and best time to call
If you are under 18, can you furnish a work permit? Yes   No
Have you filed an application here before? Yes   No
Have you ever been employed here before? Yes   No
Are you legally eligible for employment in this country? (Proof of U.S. citizenship or immigration status will be required upon employment.) Yes   No
Date available for work
Type of employment desired
Are you on a lay-off and subject to call? Yes   No
Will you relocate if job requires it? Yes   No
Will you travel if job requires it? Yes   No
Have you been convicted of a felony in the last seven (7) years? (Such conviction may be relevant if job related, but does not bar you from employment.) Yes   No
If yes, please explain
Driver's license number (If required by job)

Employment History - An Equal Opportunity Employer
List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in comments section below.
 
Employer 1
Company name
Address
Telephone
Dates employed
Job Title
Immediate supervisor and title
Summarize the nature of the work performed and job responsibilities
Starting hourly rate/salary
Final hourly rate/salary
Reason for leaving
May we contact for reference? Yes   No
 
Employer 2
Company name
Address
Telephone
Dates employed
Job Title
Immediate supervisor and title
Summarize the nature of the work performed and job responsibilities
Starting hourly rate/salary
Final hourly rate/salary
Reason for leaving
May we contact for reference? Yes   No
 
Employer 3
Company name
Address
Telephone
Dates employed
Job Title
Immediate supervisor and title
Summarize the nature of the work performed and job responsibilities
Starting hourly rate/salary
Final hourly rate/salary
Reason for leaving
May we contact for reference? Yes   No
 
Employer 4
Company name
Address
Telephone
Dates employed
Job Title
Immediate supervisor and title
Summarize the nature of the work performed and job responsibilities
Starting hourly rate/salary
Final hourly rate/salary
Reason for leaving
May we contact for reference? Yes   No
 
Comments (including explanation of any gaps in employment)

Education Background
List last three (3) schools attended, starting with last one.
 
School 1
School name
Number of years completed
Degree or diploma earned, if any
Grade Point Average or Class Rank
Major field of study (if applicable)
Minor field of study (if applicable)
 
School 2
School name
Number of years completed
Degree or diploma earned, if any
Grade Point Average or Class Rank
Major field of study (if applicable)
Minor field of study (if applicable)
 
School 3
School name
Number of years completed
Degree or diploma earned, if any
Major field of study (if applicable)
Minor field of study (if applicable)

Languages
List any foreign languages and select which best describes your skill level.
 
Language 1
Skill Level
 
Language 2
Skill Level
 
Language 3
Skill Level

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 school or personal references who are not related to you.
 
Reference 1
Full Name
Telephone
Years Known
 
Reference 2
Full Name
Telephone
Years Known
   
Reference 3  
Full Name
Telephone
Years Known

List professional, trade, business or civic associations and any offices held. (Exclude memberships which would reveal sex, race, religion, national origin, age, ancestry or other protected status.)
List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, ancestry, handicap or other protected status)
List any additional information you would like us to consider

It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. The Employer is an equal opportunity employer. The employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state or federal law.

This application is current for only (60) days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary for me to fill out a new application.
 
Are you subject to a non-compete or confidentiality agreement or restriction with respect to a former or current employer? Yes   No
If yes, please provide details

Voluntary Self-Identification (Confidential - For Statistical Use Only)
We are subject to certain governmental record-keeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, we invite all applicants to voluntarily self-identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws, executive orders and regulations.
 
Date
Full name
Job applied for
Gender Male   Female

Race/ethnic group - please select one of the following
Hispanic or Latino - A person of Mexican, Puerto Rican, Cuban, central or South American, or other Spanish culture or origin, regardless of race.

Not Hispanic or Latino - If not Hispanic or Latino, please check one of the descriptions below corresponding to the race/ethnic group with which you most identify

American Indian or Alaskan Native - A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including for example Cambodia, China, India, Japan; Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American - A person having origins in any of the Black racial groups of Africa.

Native Hawaiian or other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Two or more races

White - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Qualified applicants are considered for employment without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other characteristic protected by law.

Empire Die Casting Company is committed to being "drug free and tobacco free." All new hires must test negative for drugs and tobacco and must pass a background check. Test failure will result in termination.

Application will be kept on file for 1 year.

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