Employment Application | S.W. Rodgers Company, Inc.

PERSONAL INFORMATION

Name*

First Middle Last

Mailing Address

Street Address or PO Box City State ZIP Code

Physical Address

Street Address City State ZIP Code

Home Telephone #

Cell Phone #

Email Address*

Emergency Contact

Relationship

Phone Number

GENERAL INFORMATION

Position applied for (1)

Pay/Salary Desired

Yrs Exp

Position applied for (2)

Pay/Salary Desired

Yrs Exp

Are you over 18 years of age?

Yes
No

Date available to begin work

Are you currently employed?

Yes
No

If so, may we contact your present employer?

Yes
No

If so, please give date(s)

Have you ever been employed by S.W. Rodgers Co., Inc.?

Yes
No

If so, Please give dates

Did you participate in the Profit Sharing and/or 401(k) Plan?

Yes
No

Did you take a distribution upon termination?

Yes
No

If so, do you want to reimburse those funds back into your account, thereby receiving a credit for any prior forfeitures?

Yes
No

EDUCATION

High School

Name and Location

Dates Attended

Diploma

GED
Yes
No

Trade/Tech School

Name and Location

Dates Attended

Certificate

Yes
No

College

Name and Location

Dates Attended

Major / Degree

College

Name and Location

Dates Attended

Major / Degree

PREVIOUS WORK EXPERIENCE

Employer

From

To

Position

Pay/Salary $

Reason for Leaving

Employer

From

To

Position

Pay/Salary $

Reason for Leaving

Employer

From

To

Position

Pay/Salary $

Reason for Leaving

REFERENCES

Please list three references other than relatives or previous employers.

Name

Telephone

Address

Years Known

Name

Telephone

Address

Years Known

Name

Telephone

Address

Years Known

You may upload a resume if desired (max file size 512mb)

Accepted file types: docx, pdf, txt, Max. file size: 2 MB.

APPLICATION FORM WAIVER

PLEASE READ CAREFULLY

In exchange for the consideration of my job application by S.W. Rodgers Company, Inc. (hereinafter called "Company"), I agree that:

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 Company, 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 of the Company. Both the undersigned and the Company may end the employment relationship at any time, without specific 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, all previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.

I understand that, in connection with 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.

I understand that should I be employed by the Company, I will be required, in accordance with the Immigration Reform and Control Act of 1986 (IRCA), to provide, on my first day of employment, documents providing proof of my identity and employment eligibility status. I acknowledge that this verification is a condition of my employment and failure to comply will void my offer of employment.

I understand that the Company requires all applicants to submit to certified medical examinations as a condition of employment. These examinations are for the purpose of safety on the job and fitness for work. A positive test result for alcohol, undisclosed controlled substances, or any illegal drug will immediately void any offer of employment. I also understand that the Company requires all employees to submit to random, certified medical examinations. A positive test result for alcohol, undisclosed controlled substances, or any illegal drug could be sufficient cause for immediate termination of employment. If a chemical test result is positive, the employee will be charged for the test. Refusal to submit to the above testing will be grounds for immediate termination of employment.

I understand that my employment relationship with the Company is terminable at any time, for any reason, with or without cause or notice by either party.

I have read and understand the provisions outlined above and agree to be bound by the same and affirm that the information is complete and true. I understand that, if employed, my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relationship with the Company is terminable at will for any reason by either party. I further understand that I am required to abide by all rules and regulations of the Company as outlined in the employee handbook and/or subsequent policy statements handed out from time to time.

Printed Name of Applicant*

First Middle Last

Date*

Name

This field is for validation purposes and should be left unchanged.