APPLICATION FOR EMPLOYMENT

Please complete application in its entirety to ensure timely processing

W-L Molding of Michigan, LLC (hereafter “Company”) is an Equal Opportunity Employer. It is the Company’s policy to offer equal employment opportunity regardless of race, religion, color, national origin, sex, age, marital status, height, weight, disability, or veteran status. Michigan law requires that a person with a disability or handicap requiring accommodation for employment must notify the employer in writing within 182 days after the need is known.

PERSONAL INFORMATION


Male Female

White Black American Indian Asian Pacific Islander
Yes No
Yes No
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1 2 3 4 Yes No
1 2 3 4 Yes No
1 2 3 4 Yes No
1 2 3 4 Yes No
List below, beginning with the most recent and last three employers. Please complete even if you attach a resume.
1 From: Employer name/Type of Business:
Wages:
Starting: /Hr
Ending: /Hr 		Position: Full Time:
Yes
No 		Reason For Leaving:
To:
Duties Performed:
Supervisor's Name: Contact Number: May we contact? Yes No
2 From: Employer name/Type of Business:
Wages:
Starting: /Hr
Ending: /Hr 		Position: Full Time:
Yes
No 		Reason For Leaving:
To:
Duties Performed:
Supervisor's Name: Contact Number: May we contact? Yes No
3 From: Employer name/Type of Business:
Wages:
Starting: /Hr
Ending: /Hr 		Position: Full Time:
Yes
No 		Reason For Leaving:
To:
Duties Performed:
Supervisor's Name: Contact Number: May we contact? Yes No
4 From: Employer name/Type of Business:
Wages:
Starting: /Hr
Ending: /Hr 		Position: Full Time:
Yes
No 		Reason For Leaving:
To:
Duties Performed:
Supervisor's Name: Contact Number: May we contact? Yes No

certify that all of the information furnished on this Application is true, complete and correct. I understand and agree that any falsification, misrepresentation or omission of fact, either on this Application or during the pre-hire process, will be reason for (1) my not being offered employment, or (2) dismissal at any time from the service of Company, if employed.

I understand that consideration for employment at Company, is conditional upon a review of my qualifications, work history, references, etc. I authorize, Company, to request and obtain verification that the information given by me on this Application is true, accurate and complete. I understand that such verification may include, but may not be limited to background information pertinent to the position for which I have applied, verification of education, verification of employment history, investigation of criminal history, etc. I therefore authorize my current and all previous employers to cooperate with Company, and to release, on a confidential basis, any information they may have concerning me, including information in my personnel record or otherwise known to them, to Company, in connection with my application for employment with Company. I specifically release from liability any current or former employer(s), its agents, representatives, employees, officers, directors, etc., for or on account of their providing/disclosing such information to Company.

I understand and agree that my employment and compensation is for no definite period and may, regardless of the time and manner of payment of my wages and salary, be terminated at any time by me or the Company, with or without cause, and with or without any previous notice. I also understand and agree that the Company has the right to unilaterally modify and/or terminate any policies, practices, procedures and standards it has adopted or implemented, to the extent not prohibited by law. I acknowledge that no Company employee nor representative, other than the President, has either the power or authority to enter into any agreement for employment for any specified period of time, or to make any representations or agreements contrary to any of the foregoing, unless that agreement is in writing and is signed by the President. I understand that any prior representations, promises, contracts or statements made by or on behalf of the Company are expressly superseded by the foregoing.

The Immigration Reform and Control Act of 1986 states that employers must require all persons hired to submit documents to the employer showing their identity and their right to be lawfully employed in the United States. It also requires that the employee complete and sign a government form to this effect. I understand that if hired by Company, I will timely furnish documents for inspection that verify my identity and that I am legally permitted to work in the United States. Furthermore, I understand that my employment will be terminated if I fail to timely provide the necessary documents.