Call: +1(315) 782-3000 Info@StebbinsEng.com

The STEBBINS Engineering and Manufacturing Company

Name:
Social Security No.:
Address:
How were you referred for employment :
Have you ever worked for Stebbins before?
Have you applied for work with Stebbins before?
Position applying for:
Are there any aspects of the job for which you are applying you are unable to accomplish?
Type of employment desired:
Will you work:
Is there any time of the day or any day of the week you are unable to work?
Are you presently employed?
Do you have the legal right to work in the United States?
Are you over 18 years of age?
Do you intend to work anywhere else in addition to working at Stebbins?
Do you have a drivers license?
Have you ever been bonded?
Have you ever been denied bond coverage?
EMPLOYMENT HISTORY: Please list all positions for the past 10 years, giving present or last positions first. Use additional pages if necessary.
1.
Dates Worked:
Wage or Salary:
2.
Dates Worked:
Wage or Salary:
3.
Dates Worked:
Wage or Salary:
4.
Dates Worked:
Wage or Salary:
5.
Dates Worked:
Wage or Salary:
May we contact the employers listed above?

Please account for all periods of unemployment longer than three (3) months:

Have you ever been convicted of a crime by a civilian or military court (other than a minor traffic violation) ?
Were you in the U.S. Armed Forces?
Dates of duty:

PLEASE COMPLETE THIS SECTION IF YOU ARE APPLYING FOR A CLERICAL POSITION ONLY. CHECK SKILLS & TRAINING ACQUIRED:
EDUCATION:
NAME AND ADDRESS OF SCHOOL:
COURSE OF STUDY:
LAST YEAR COMPLETED:
GRADUATED?
DEGREE OR DATE LAST ATTENDED:
High School:



College:



Other:



List any additional work experience, skills, information, licenses, certifications, special study, or research work relating to position applied for or of general interest:

Is any information necessary to enable a check of your records such as a change of name, use of an assumed name, or nickname? If yes, please explain

PLEASE LIST ANY RELATIVES OR FRIENDS EMPLOYED BY STEBBINS:
1.
2.
3.
PERSONAL REFERENCES: Please list three business people, professionals, or other persons who are not relatives, former employers, or employees of The Stebbins Engineering and Manufacturing Company.
1.
2.
3.

IMPORTANT: READ CAREFULLY

         I certify that my answers to the foregoing questions are true and correct and understand that any false or misleading information or omission on the application shall be sufficient cause for rejection or immediate dismissal.  I hereby authorize release of any information regarding any criminal convictions that may exist against me, and ask my former employer(s) and all the other persons named herein who might have information concerning me, to give any information regarding my former employment or any other information they many have regarding me whether or not the same as a matter of record, and hereby release them and each of them from any liability for any damage whatsoever which I could or might claim because of such disclosure.

         In making this application for employment, it is understood and accepted that as part of the application and employment process, and or during employment with The Stebbins Engineering and Manufacturing Company.  I may be asked to submit to physical examinations which may include testing for alcohol and drugs, and/or be fingerprinted, all in accordance with law.  By submitting this application, I hereby agree to submit to such examinations, tests, and fingerprinting.

         I understand that the use of this form does not indicate that there are positions open and does not in any way obligate The Stebbins Engineering and Manufacturing Company.  If employed, I agree to abide by and observe all Company rules and regulations.  I further understand that any such future employment is terminable by either party at will and without notice or cause.  No person other than the President of Stebbins Engineering and Manufacturing Company may modify or amend the provisions stated herein.

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