- Fort Wayne Metals

Employment Form

Employment Form

Employment Record

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General

Application Type

Personal

Education

References

Employment Record

EEOC Compliance

Military

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General

Signature

References
	Print name, address, and years known for FOUR persons who have known you professionally for at least TWO years.
	Last Name, First Name, Initial	Address City, State & Zip	Phone	Years Known
	1.
	2.
	3.
	4.

Please give accurate, complete full-time and part-time, employment record. Start with the present or most recent employer

1	Company Name	Telephone
	Address	Employed (State Month and Year) From To
	Name of Supervisor	Weekly Pay Start Last
	State Job Title and Describe your Work	Reason for Leaving

2	Company Name	Telephone
	Address	Employed (State Month and Year) From To
	Name of Supervisor	Weekly Pay Start Last
	State Job Title and Describe your Work	Reason for Leaving

3	Company Name	Telephone
	Address	Employed (State Month and Year) From To
	Name of Supervisor	Weekly Pay Start Last
	State Job Title and Describe your Work	Reason for Leaving

4	Company Name	Telephone
	Address	Employed (State Month and Year) From To
	Name of Supervisor	Weekly Pay Start Last
	State Job Title and Describe your Work	Reason for Leaving

We may contact the employers listed above unless you indicate those you do not want us to contact.

Do Not Contact Employer Number(s)
Reasons:

Military
	Complete This Section if you Served in the U.S. Armed ForcesDescribe your duties and any special training.	Branch of Military Service
		Period of Active Duty (Month and Year) From To
		Rank at Discharge
		Present Status

Resume:

How did you hear about us?

Signature
	I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Fort Wayne Metals Research Products Corporation to hire me. If I am hired, I understand that either Fort Wayne Metals Research Products Corporation or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Fort Wayne Metals Research Products Corporation has the authority to make any assurance to the contrary. I have been informed that Fort Wayne Metals Research Products Corporation will comply with its obligation to provide reasonable accommodations to qualified individuals with disabilities. I attest that with my signature below that I have given to Fort Wayne Metals Research Products Corporation true and complete information on this employment application. No requested information has been concealed. I authorize Fort Wayne Metals Research Products Corporation to contact references provided. I agree to hold such persons harmless with respect to any information they may give about me. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for denial of employment or immediate dismissal.
	Check here to agree to the terms listed by the disclaimer *
	Date: * Signature *

* - required fields Application Type
Professional Production
Personal
	Last Name: *	First Name: *	Middle Initial:	Date: *
	Street Address: *			Home Telephone: *
	City: *	State: *	Zip: *	Business Phone:
	Have you ever applied for employment with us? Yes No If yes: Month and Year:		Work Location Preference
	Position Desired *		Shift Preference 1st 2nd 3rd	Pay Expected
	Apart from absence for a religious observance, are you available for full-time work? * Yes No If no, what hours can you work?		Will you work overtime if asked? * Yes No
	Are you legally eligible for employment in the United States? *		When will you be available to begin work? *
	Other special training or skills(languages, machine operations, etc.)		How did you hear about Fort Wayne Metals Research Products Corporation?

EEOC Compliance
This company is dedicated to a policy of affirmative action and equal opportunity without regard to race, religion, gender, sexual orientation, national origin, age, veteran or disabled status, or any other protected class. Reasonable accommodation will be made as appropriate to enable any employee or applicant for employment to safely and properly perform the job applied for as requested and as appropriate. The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil laws and regulations. In order to comply with these laws, the employer invites employees to voluntarily self-identify their race or ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual.
Sex:	Male Female I choose not to provide gender information
Ethnicity:	Hispanic or Latino
Ethnic Background:	Native Hawaiian or Other Pacific Islander - Any person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian - Person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. White - Any person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black of African American - A person having origins in any of the Black racial groups of Africa. American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. Two or more races (for persons who identify with more than one of the races above) I choose not to provide race information
Veteran Status:	Disabled Veteran Recently Separated Veteran Armed Forces Service Medal Veteran Other Protected Veteran I choose not to provide this information

name and Location of School

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of Study

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Years
Completed

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Graduate

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Diploma

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