Dupps Employment Application

Attach Resume (Optional)

Name (Full-Last, First, MI) *

Email Address *

What date are you available to start work? *

Street Address, City State Zip *

Home Phone *

Cell Phone

Do you have any friends or relatives working here? *
Yes
No

If so, please list

Have you previously been employed by our company? *
Yes
No

Employed Here From

Employed Here To

Are you legally authorized to work in the United States? *
Yes
No

Can you provide proof of eligibility to work in the US? (Proof of eligibility will be required before you can be employed) *
Yes
No

Are you 18 years of age or older? *
Yes
No

Position Applied For *

Desired Wage / Salary

Are you willing to work: (check all that apply) *
Full Time
Part Time
Weekends
Overtime
Second Shift
Temporary

Education

HS: Name and Location *

Grade completed *
9
10
11
12

Graduated *
Yes
No

If no, have you received a GED?
Yes
No

College: Name and Location

Number of Years Attended

Degree Received or Expected

Grade Average

Course Major/Field

College: Name and Location

Number of Years Attended

Degree Received or Expected

Grade Average

Course Major/Field

Trade, Business, Correspondence School: Name and Location

Number of Years Attended

Degree Received or Expected

Grade Average

Course Major/Field

Other job-related, educational institutions, licenses, certifications, specialized training, apprenticeship, skills or any additional information you feel may be helpful to us in considering your application.

EMPLOYMENT HISTORY (List below last employers, starting with the most recent one first)

Present or Last Position

Name of Company

Employed From

Employed To

Address (City, State Zip)

Duties

Reason for Leaving

Starting Annual Salary/Hourly Rate

Ending Annual Salary/Hourly Rate

What did you like least about this job?

Name of Supervisor

Title and Department of Supervisor

Phone Number of Supervisor

If currently employed, may we contact your supervisor?
Yes
No

Next Previous Position

Name of Company

Employed From

Employed To

Address (City, State Zip)

Duties

Reason for Leaving

Starting Annual Salary/Hourly Rate

Ending Annual Salary/Hourly Rate

What did you like least about this job?

Name of Supervisor

Title and Department of Supervisor

Phone Number of Supervisor

Next Previous Position

Name of Company

Employed From

Employed To

Address (City, State Zip)

Duties

Reason for Leaving

Starting Annual Salary/Hourly Rate

Ending Annual Salary/Hourly Rate

What did you like least about this job?

Name of Supervisor

Title and Department of Supervisor

Phone Number of Supervisor

REFERENCES - List three business references that have knowledge of your work ethic, experience, and ability. (Do not include realatives)

Name

Company

Phone Number

Occupation

Name

Company

Phone Number

Occupation

Name

Company

Phone Number

Occupation

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

Have you ever been convicted of a felony or misdemeanor? *
Yes
No

If so, please explain below giving date, charge, county & all other detailed matter pending and current status. An applicant is not required to provide a response regarding conviction records sealed under the Ohio First-Offenders law unless we advise you that this question is substantially related to a position for which you may be considered.

If applying for a position that requires driving, do you have a valid driver's license?
Yes
No

Please list the dates and description of all chargeable accidents:

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY

JOB APPLICANTS AGREEMENT AND CERTIFICATION

In consideration of my employment, I agree to conform to the policies and procedures of the company. I understand that in accepting this application, the company is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered. Furthermore, if employed, I understand that I am employed at will and that my employment and compensation can be terminated with or without reason, and with or without notice at any time.

I understand that this application will be kept on file for one year from the date completed, after which time I would have to reapply in accordance with established company procedures.

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any misrepresentation or falsification of information or significant omissions on either this application or during the pre-employment process will result in my application being rejected, or, may result in my subsequent dismissal if I am hired.

I also understand that any offer of employment is conditioned on pre-employment procedures, which includes a background check, tests and documentation. I will, upon request, sign all necessary consent and authorization and release forms. I voluntarily and knowingly authorize the company and/or its agents, to verify any aspect of the information contained in my employment application or through public and private sources. I authorize any third party organization to perform a consumer report and background investigation. I also authorize and consent any companies, schools or persons listed on this application (or accompanying resume) to give any information regarding my employment, qualifications and character to The Dupps Company. I understand that the employment information may include, but is not necessarily limited to, performance evaluation and reports, job descriptions, disciplinary reports, letters of reprimand, and opinions regarding my suitability for employment possessed by it.

I voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless you, your agents and any former employer, person, firm, corporation, school or government agency, its officers, employees and agents from any and all claims, liability, demands, causes of action, damages, or costs, including attorney's fees, present or future, whether known or unknown, anticipated or unanticipated, arising from or incident to the disclosure or release of any such information to you, your agents, or consumer reporting agency.

I understand that I will be required to take a drug test as a part of the application process, as a condition of employment or at any time during employment. I will also be required to take a physical exam if I am selected for employment and before beginning employment.

I agree that any claim or lawsuit relating to my service with The Dupps Company must be filed no more than six (6) months after the date of the action that is the subject of the claim or lawsuit. I waive any statute of limitations to the contrary.

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