Online Application - Intertech Products, Inc.

We are an equal opportunity employer and do not unlawfully discriminate in employment. No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Equal access to employment, services, and programs is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the organization.

APPLICANTS WILL BE TESTED FOR ILLEGAL DRUGS
Name:*
First Middle Last Maiden
Current Address:*
Number Street City State Zip
Previous Address:
Number Street City State Zip
Home Phone:*
Cell Phone:
Email:*
Are you at least 18 years old?*
- Yes
- No
Position applied for and salary desired (Be specific):*
Position Salary
Days/hours available to work:
No Pref
Thur
Mon
Fri
Tue
Sat
Wed
Sun
How many hours can you work weekly?*
Can you work nights?*
Employment desired:*
- FULL-TIME ONLY
- PART-TIME ONLY
- FULL - OR PART-TIME
When available for work?*
Education*
Type of School (High School, College, Bus. or Trade School) Name of School City and State Completed (Yes/No) Major & Degree (Diploma, GED, etc.)

Click the + symbol to add additional rows.
DO YOU HAVE A DRIVER'S LICENSE?*
- Yes
- No
What is your means of transportation to work?*
Driver's license number:
State of issue:
Expiration date:
Driver's License Types:
- Operator
- Commercial (CDL)
Have you had any accidents during the past three years?
- Yes
- No
How many?*
Have you had any moving violations during the past three years?*
- Yes
- No
How many?*
BUSINESS EQUIPMENT SKILLS
Typing*
- Yes
- No
WPM:
Personal Computer:*
- Yes
- No
Computer Systems:
- PC
- Mac
Other Business Equipment Skills:
MILITARY
HAVE YOU EVER BEEN IN THE ARMED FORCES?*
- Yes
- No
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?*
- Yes
- No
Specialty:
Date Entered:
Discharge Date:
Type of discharge?
- Honorable
- Other than Honorable
- Dishonorable
OTHER QUALIFICATIONS OR SKILLS
List any job-related training, skills, licenses, certificates, and/or other qualifications:
Do you have a dependable transportation to and from work?*
- Yes
- No
Can you work in hot conditions? (over 90 degrees)?*
- Yes
- No
Are you able to work overtime without prior notice if needed?*
- Yes
- No
Do you have prior manufacturing experience and/or education?*
- Yes
- No
Have you ever been previously employed by our organization?*
- Yes
- No
Can you submit proof of legal employment authorization and identity?*
- Yes
- No
Can you work a flexible shift if required?*
- Yes
- No
Can you read, write and do basic math to proficiently complete production paper-work and read and comprehend work instructions?*
- Yes
- No
How were you referred to us?*
Relationship:
Sources:
- Internet
- Print Ad
- Sign
- Other
Other:
Employment History
Please provide all employment information for your past four employers starting with the most recent.
Employer One:
Position Held:
Address
Street Address City State ZIP
Immediate Supervisor:
Dates Employed: From:
MM slash DD slash YYYY
Dates Employed: To:
MM slash DD slash YYYY
Salary:
Job Summary:
Reason for leaving:
May we contact?
- Yes
- No
Employer Two:
Position Held:
Address
Street Address City State ZIP
Immediate Supervisor:
Dates Employed: From:
MM slash DD slash YYYY
Dates Employed: To:
MM slash DD slash YYYY
Salary:
Job Summary:
Reason for leaving:
May we contact?
- Yes
- No
Employer Three:
Position Held:
Address
Street Address City State ZIP
Immediate Supervisor:
Dates Employed: From:
MM slash DD slash YYYY
Dates Employed: To:
MM slash DD slash YYYY
Salary:
Job Summary:
Reason for leaving:
May we contact?
- Yes
- No
Employer Four:
Position Held:
Address
Street Address City State ZIP
Immediate Supervisor:
Dates Employed: From:
MM slash DD slash YYYY
Dates Employed: To:
MM slash DD slash YYYY
Salary:
Job Summary:
Reason for leaving:
May we contact?
- Yes
- No
References
List 3 references names, telephone numbers, and years known (do not include relatives):
References:*
Name Telephone Number Years Known

Click the + symbol to add additional lines.
Applicant’s certification, authorization and acknowledgement:
In exchange for the consideration of my job application by Intertech Products, Inc. (herein after called “the Company”), I agree that:

I certify that the facts set forth in this employment application are true and complete to the best of my knowledge. Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of by Intertech Products, Inc. or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /Manager Director of the Company. Both the undersigned and by Intertech Products, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I may be required to submit to a medical review and I may be required to complete a medical history form and be examined by a medical professional designated by the company. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.
Printed Name:*

Please include your FULL name.
Date:
MM slash DD slash YYYY
Thank you for completing this application form and for your interest in our business.
Applicant Information Release
I hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold Intertech Products, Inc., any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process.
Printed Name:*

Please include your FULL name.
Date:
MM slash DD slash YYYY
The Company is an equal opportunity employer and does not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, veteran status, citizenship or any other characteristic protected by federal, state or local laws.
Email
This field is for validation purposes and should be left unchanged.

Online Job Application

Employment History

References

Applicant’s certification, authorization and acknowledgement:

Applicant Information Release

Apply offline by downloading our employment form

Type of School (High School, College, Bus. or Trade School)	Name of School	City and State	Completed (Yes/No)	Major & Degree (Diploma, GED, etc.)

Position	Salary

Name	Telephone Number	Years Known