920-206-1480 info@gvmachine.com EMPLOYMENT APPLICATION Employment Application Fields marked with an * are required We are an Equal Opportunity Employer Date Applicant Information Last Name * First Name * Middle Name * Address * City * US States * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * Email Day Phone Evening Phone Are there other names under which you have worked or attended school? * yes no If yes, please list for reference checking purposes. Are you legally authorized to work in the U.S.? * yes no If hired, you will be required to provide proof of work authorization. Are you 18 years or older? * yes no If not, your employment will be subject to verification that you meet state/federal minimum age requirements for the type of work you are applying for and have obtained a valid work permit. Have you ever been convicted of a crime or pleaded no contest for any offense or violation other than minor traffic violations? * yes no Convictions are not an automatic bar to employment If yes, explain 1) nature of the charges, 2) date of convictions, and 3) state in which convicted. Do you have any pending criminal charges against you? * yes no If yes, explain 1) nature of the charges, 2) date issued, and 3) county and state issued Copy Have you ever applied at this company before? * yes no If yes, when? Have you ever worked at this company before? * yes no If yes, when? Position Applying For What position are you applying for? * Part-Time or Full-Time? * Salary Preference Shift Preference How were you referred to the company? * Agency Walk-in Newspaper School Employee Internet Friend/Relative Other Referral? yes no If yes, who? Resume Upload SELECT FILES Cover Letter Upload SELECT FILES Special Skills If relevant, please describe experience using manufacturing machines and equipment. Equipment Operated | Manufacturer's Name | If CNC, List Control Type If relevant, please describe experience using manufacturing machines and equipment. Performance Ability Normal daily work at G & V Machine Co. may require you to lift up to 50 pounds repetitively. Can you accomplish this with or without accommodations? * yes no Education High School Name & Location Major Subjects Diploma or Degree Received? yes no Type of Degree: College Name & Location Major Subjects Diploma or Degree Received? yes no Type of Degree: Graduate School Name & Location Major Subjects Diploma or Degree Received? yes no Type of Degree: Other Training Courses Organization Sponsoring Dates Attended Course-Seminar Diploma or Degree Received? yes no Type of Degree: Employment History Name & Address of Company Phone of Employer From To Starting & Final Wage Job Title Description of Duties Name of Immediate Supervisor If currently employed, may we contact as a reference? Reason Left/Additional Notes Name & Address of Company Phone of Employer From To Starting & Final Wage Job Title Description of Duties Name of Immediate Supervisor Reason Left/Additional Notes Name & Address of Company Phone of Employer From To Starting & Final Wage Job Title Description of Duties Name of Immediate Supervisor Reason Left/Additional Notes Employment References List individuals familiar with your job qualifications (no relatives or personal friends.) Name Phone Evening Phone Address Relationship How long known? Name Phone Evening Phone Address Relationship How long known? Name Phone Evening Phone Address Relationship How long known? Please Read Carefully Before Signing This Form All information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I authorize the company to investigate my responses on this application and contact any of all my former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information, whether favorable or unfavorable, about me or my employment. I voluntarily and knowingly fully release and hold harmless any person or organization that provides information pertaining me or my employment. I understand that upon receiving a job offer, a physical examination and drug screening may be required. (Note: If this is a job requirement, you will be notified) Regardless of whether or not I become employed by the company, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at the company is on an at-will basis and that my employment may be terminated with or without cause, and without notice, at any time, at my option or the company's, unless specifically provided otherwise in a written employment contract. I further understand that no company employee or representative has the authority to enter into a contract regarding duration or terms and conditions of employment other than an officer of the company, and then only by means of a signed, written document. This application is good for 1 year. Digital Signature * Date * G & V MACHINE COMPANY N8100 Industrial Dr. Ixonia, WI 53036 Email: info@gvmachine.com Phone: 920-206-1480 AN ISO 9001 CERTIFIED, WOMAN OWNED BUSINESS MEMBERS OF WISCONSIN MANUFACTURERS & COMMERCE MEMBERS OF MRA © 2021 G & V Machines Company. All rights reserved. Site designed and maintained by Paragon Marketing Group.