Employment Application

Position Information

Position Applied For: *

Contact Information

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Website/Profile:

First Name: *

Middle Name:

Last Name: *

Phone: *

Email:

General Information

How did you hear about us?:

Ever worked at APG?: *

If yes: When:

Last position:

Supervisor?:

Eligibility Information

Are you over the age of 18?: *

If no, you may be required to provide authorization to work

Are you legally eligible for employment in the United States?: *

If offered employment, you will be required to provide documentation to verify eligibility.

Are you able to perform the essential functions of the position for which you are applying, with or without accommodation?: *

In the last ten years have you ever been convicted of a crime other than a minor traffic violation?: *

A conviction will not necessarily disqualify you from employment.

If Yes: Explain:

Availability

Start Date: *

Desired Salary/Rate:: *

Employment History

Employer: *

Address:

City: *

State: *

Zip Code:

Telephone:

May we contact this employer?: *

Job Title: *

Immediate Supervisor:

Date Employed From: *

To: *

Compensation:

Reason for Leaving:

Summarize the type work performed and job duties: *

Employment History 2

Employer:

Address:

City:

State:

Zip Code:

Telephone:

May we contact this employer?:

Job Title:

Immediate Supervisor:

Date Employed From:

To:

Compensation:

Reason for Leaving:

Summarize the type work performed and job duties:

Employment History 3

Employer:

Address:

City:

State:

Zip Code:

Telephone:

May we contact this employer?:

Job Title:

Immediate Supervisor:

Date Employed From:

To:

Compensation:

Reason for Leaving:

Summarize the type work performed and job duties:

Educational Background

High School

Name & Address: *

Major Subject:

Degree:

Years Completed: *

Graduated: *

College

Name & Address:

Major Subject:

Degree:

Years Completed:

Graduated:

Graduate School

Name & Address:

Major Subject:

Degree:

Years Completed:

Graduated:

Business/Trade

Name & Address:

Major Subject:

Degree:

Years Completed:

Graduated:

Other School

Name & Address:

Major Subject:

Degree:

Years Completed:

Graduated:

Other Skill and Qualifications

Please proved any relevant training, skills, or certifications that may assist you in this position:

Computer Skills (please describe):

References

Please proved three work related references that are not previous supervisors. Or provide three school or personal references that are not related to you.

Reference 1

Name:

Title/Company:

Relation to you:

Phone:

Address:

Years known:

Reference 2

Name:

Title/Company:

Relation to you:

Phone:

Address:

Years known:

Reference 3

Name:

Title/Company:

Relation to you:

Phone:

Address:

Years known:

Affirmative Action Program Voluntary Opportunity to Self Identify

Automation Products Group is an Equal Opportunity Employer and as such we record certain information to be part of our
Affirmative Action Program.

To assist us in complying with governmental regulations we ask that you complete this applicant data survey. This survey is
to be completed by the applicant on a voluntary basis. It is not used for interviewing purposes and is to be filed separately
from the employment application.

Providing this information is strictly voluntary. Refusal to provide this information will have no bearing on your application.

Please check one of the following Identification groups:

Veteran Status Information:

Notification And Agreement

PLEASE READ BEFORE SIGNING

I understand that Automation Products Group is an equal opportunity employer. Automation Products Group does not discriminate in
employment on account of race, color, religion, national origin, citizenship status, age, sex, sexual orientation, marital status, disability,
military status, or any other class protected by federal, state, or local law. Automation Products Group likewise will not tolerate any form of
harassment. All complaints of harassment are taken seriously and will be investigated.

I certify that the information provided in the above employment application is true and complete to the best of my knowledge. I understand
that the falsification, misrepresentation, or omission of fact on this application (or any of the accompanying or required documents) will be
cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

I authorize the investigation of all of the statements and information contained in this application. I understand that an investigative
consumer report may be conducted. I release all parties from any and all liability or claims from furnishing such information. I also release
the employer from all liability that may result from making an investigation.

I consent to participate in drug and/or alcohol testing following an offer of employment. I understand that hired employees of this company
who refuse to participate in a test, and those who fail a test or adulterate a test, are subject to disciplinary action, including termination.

I understand that completion of this Application for Employment does not guarantee that I have been employed by Automation Products
Group. I further understand that no representation, whether oral or written by any representative or agent other than the President of
Automation Products Group, at any time, can constitute a contract of employment. I understand that if hired my employment may be
terminated, with or without notice, at any time at the option of either me or Automation Products Group, unless required by law.

I understand that this Application for Employment remains current for 30 days, after which it will be necessary for me to re-apply and fill out
a new application.

I certify that I have read, fully understand and accept the above Notification and Agreement statement.

Signature of Application: *

Date: *

Upload Resume:

Level Sensors and Pressure Gauges

Search

Employment Application

Contact Details

Automation Products Group, Inc.

PLEASE READ BEFORE SIGNING