Remcon Plastics
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Remcon Plastics

Job Application Form

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Job Application
Job ID
Job Title
Job Application ID

Equal Opportunity Employer

At Remcon, we offer an environment that inspires progress. Our employees get a real sense of satisfaction and accomplishment by the work they do. Continuous learning and improvements contribute greatly to their success as well as the success of Remcon. We ALL work together, holistically, by focusing on both our Brand Promise and our Core Purpose.

Personal Information
Last Name
First Name
Middle Name
Social Security Number
Present Address
City
State
Zip Code
Phone
Position Applied For
Please indicate what shift(s) you are AVAILABLE to work:(check all that apply)
What is your required salary/hourly rate?
When would you be available to begin work?
Are you willing to work overtime?
Can you work Saturday?
Can you work Sunday?
Are you eligible to work in the United States?
Are you 18 years or older?
Do you have any relatives or friends who are currently employed by Remcon Plastics?(please list)
0 /
Have you ever been convicted of a crime, excluding misdemeanors?
If yes, please explain:(Note: Conviction of a crime is not an automatic disqualification for employment.)
0 /
Have you previously been employed by this company?
If Yes, what was your position?
Education
High School
Name/Location
No. Years Attended
Degree
Major Area(s) of Study
College
Name/Location
No. Years Attended
Degree
Major Area(s) of Study
Trade, Business or Other School
Name/Location
No. Years Attended
Degree
Major Area(s) of Study
School Graduate
Name/Location
No. Years Attended
Degree
Major Area(s) of Study
Employment
Employer 1
From:Month/Year
To:Month/Year
Employer's Name, Address & Phone Number
Wage/Salary
Position/Title
Supervisor's Name
Reason for leaving
Employer 2
From:Month/Year
To:Month/Year
Employer's Name, Address & Phone Number
Wage/Salary
Position/Title
Supervisor's Name
Reason for leaving
Employer 3
From:Month/Year
To:Month/Year
Employer's Name, Address & Phone Number
Wage/Salary
Position/Title
Supervisor's Name
Reason for leaving
Please list any additional employers, if necessary
0 /
May we contact your current employer?
Have you ever been discharged or asked to resign from a job?
If yes, please explain:
0 /
Are you able to perform the essential functions of the position for which you are applying?
REFERENCES

Do Not Include Relatives or Former Employers.

Reference 1
Name
Address, City, State & Zip Code
Telephone
Years Known
Reference 2
Name
Address, City, State & Zip Code
Telephone
Years Known
Reference 3
Name
Address, City, State & Zip Code
Telephone
Years Known
EQUAL EMPLOYMENT OPPORTUNITY DATA

Completion of this form is entirely voluntary, and all information will remain confidential and will not affect your application for employment. We are required by law to collect this information to satisfy federal equal opportunity statistical reporting and research requirements. This section will be detached from the appplication after processing and will not become a part of your personal record if this company hires you.


Name:
Position Applied For:
Gender:
Race/Ethnicity
How did you learn about this job opportunity?
Please list employee name:
Please specify:(Newspaper Ad)
Please specify:(other)
Government contractors must take affirmative action to employ and advance certain qualified individuals subject to the Rehabilitation Act of 1973 and the Vietnam Era Veterans Readjustment At of 1974. Completion of the following information is voluntary, and will assist us in proper placement and reasonable accommodation. If you wish to be identified as qualifying for such placement or accommodation, please check where applicable.
Background Information

Applicants/Employees: Please provide the following information to facilitate a background check for: REMCON PLASTICS, INC.

Last Name
First Name
Middle Name
I have no middle name
Other Name/Alias
Social Security #*
Date of Birth*
date_range
Phone
Driver's License #
State of Driver's License **
Present Address
City/State/Zip
Please list any former address(es) over the past 7 years, including approximate dates:
AddressDates
×
(1)
May we contact your current employer?

The following information will be used for the application of state-specific or compensation-specific consumer reporting restrictions:

Anticipated Salary or Annual Compensation:

READ THIS INFORMATION BEFORE SIGNING YOUR JOB APPLICATION FORM!

Federal Law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof ofemployment authorization and identity (valid driver's license, birth certificate, Green cord, etc.) within threedays of being hired. Failure to submit proof within the required time shall result in immediate employmenttermination.I understand that the use of this application form does not imply that there are positions open and does not inany way obligate Remcon Plastics, Inc. to employ job applicants. Remcon Plastics, Inc. reserves the right torequest any Individuals who are offered positions of employment to take any necessary physical tests orexaminations as are authorized by law and required by Remcon Plastics, Inc. policy and procedures. Such testsmay include a substance abuse screening examination.I certify that the facts contained in this application are true and complete to the best of my knowledge thatfalse statements on this application shall be grounds for rejection, discipline or dismissal.I authorize full investigation of all statements contained herein and any other information which may have apossible bearing on my employment including allowing Remcon Plastics, Inc. to contact all companies, schoolsand persons named to give information regarding my employment, character and qualifications. I release allparties from any and all liability for any damage that may result from furnishing such information to you.I understand and agree that, it hired, my employment is not for a definite period and may, regardless ofcircumstances, be terminated at any time without prior notice by Remcon Plastics, Inc.. I understand that norepresentative of the Company, other than the President, has the authority to enter into any agreement foremployment for any specified period of time, or to make any agreement contrary to the foregoing.By signing this application form, you are attesting that you have fully read, understood and agree to all of theabove stated information.

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

I acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUNDINVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certifythat I have read and understand both of those documents, I hereby authorize the obtaining of "consumer reports"and/or "investigative consumer reports" by REMCON PLASTICS, INC.("Employer") at any time after receipt of thisauthorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, anylaw enforcement agency, administrator, state or federal agency, institution, school or university (public or private),information service bureau, employer, or insurance company to furnish any and all background information requestedby HR Screening Services, Inc., 521 Cedar Way, Oakmont, PA 15139, 800-261-6268, www.hrscreening.com and/orEmployer. 1 agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as theoriginal. New York applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Employer, and if such report was requested, informed of the name and address of the consumerreporting agency that furnished the report. You have the right to inspect and receive a copy of anyinvestigative consumer report requested by the Employer by contacting the consumer reporting agencyidentified above directly. By signing below, you acknowledge receipt of Articie 23-A of the New YorkCorrection Law.New York City applicants only: You acknowledge and authorize the Employer to provide any notices required byfederal, state or local law to you at the address(es) and/or email address(es) you provided to theEmployer, Washington State applicants only: You also have the right to request from the consumer reporting agency awritten summary of your rights and remedies under the Washington Fair Credit Reporting Act.Minnesota and Oklahoma applicants only: Please check this box if you would like to receive a copy of a consumerreport it one is obtained by the Employer.

DISCLOSURE REGARDING "INVESTIGATIVE CONSUMER REPORT" BACKGROUND INVESTIGATION 

REMCON PLASTICS, INC.(the "Company"), to which you have applied for employment, may request aninvestigative consumer report about you from a third party consumer reporting agency, in connectionwith your employment or application for employment (including independent contractor or volunteerassignments, as applicable), An "investigative consumer report" is a background report that includesinformation from personal interviews (except in California, where that term includes background reportswith or without information obtained from personal interviews). The most common form of aninvestigative consumer report in connection with your employment is a reference check throughpersonal interviews with sources such as your former employers and associates, and other informationsources. The investigative consumer report may contain information concerning your character, generalreputation, personal characteristics, mode of living, or credit standing. You may request moreinformation about the nature and scope of an investigative consumer report, if any, by contacting theCompany.You have the right, upon written request made within a reasonable time, to request (1) whether aninvestigative consumer report has been obtained about you, (2) disclosure of the nature and scope ofany investigative consumer report and (3) a copy of your reports These reports will be conducted by HRScreening Services, Inc., 521 Cedar Way, Oakmont, PA 15139, 800-261-6268, www.hrscreening.com.The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from anyoutside organization all manner of investigative consumer reports throughout the course of youremployment to the extent permitted by law.

I agree

*This information will be used for background screening purposes only and wilt not be used as hiring criteria.
** it you will be requesting driving records, we recommend that you have this form notarized.

Note: if you do business in Utah, you cannot ask for DOB, driver's license, or SSN until either a confidential offer otemployment or at the
time the background report will be run.

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