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Today's Date:

A thorough understanding of your experience and qualifications will assist us in the hiring process and in your placement into the right position.

Phone Number:

Emergency Contact Info:

Emergency Contact Info:

Are you 18 years or older?

Are you legally eligible to work in the U.S.?

Have you worked at H&L Manufacturing before?

Have you worked here under a different name?

Do you have friends or relatives working here?

Are you available to work 1st shift?

If yes, what dates?

If yes, what name?

If yes, who?

Are you available to work 2nd shift?

Are you available to work 3rd shift?

Are you available for Full-Time?

Are you available for Part-Time?

What type of position are you applying for?

Earnings Expected:

per hour

How were you referred to H&L Manufacturing?

What machines or equipment can you operate?

Have you been convicted of a crime?

If yes, what?



Are you presently on parole?

If yes, for what offense?

When does parole end?

Have you served in the U.S. military?

Have you had people reporting directly to you?

Have you been responsible for training people?

If yes, which brach?

Dates of service?

If yes, how many?

If yes, how many?

If hired, what date can you start working?


High School Information

Did you graduate?

College Information

Did you graduate?

Personal References (List only those who can give a business reference)
Employment History (List the most recent employer first)

Employed from:

Employed to:

May we contact?

Employed from:

Employed to:

May we contact?

Employed from:

Employed to:

May we contact?

This application is made on the following conditions:

Do you agree with the statement/terms below?

The statements in this application completed by me and any resume submitted by me are absolutely true and correct.  Any false statements or misrepresentations could result in my not being eligible for employment or in termination.

I authorize the Company to make inquiries and request any information that may lawfully  be obtained from the persons and companies noted and referred to in this application form and noted in any resume, letter or other material furnished by me, and any consumer, credit or investigative reporting agencies.  I agree that no person or organization shall be liable as a consequence of the answers to such inquiries.  I hereby waive written notice of any prior employment disclosure or disciplinary or other information concerning me.  I agree to submit to lawful physical and drug examinations before and during my employment at the request and expense of the Company, and to disclose completely all information lawfully requested at such examinations.

I understand and agree that all employment at H&L Manufacturing is on an at will basis and may be terminated by the employee or employer at any time for any cause or no cause.  I further understand and agree that all benefits, programs, rules and regulations and policies of the Company are subject to change at any time by the Company.  I understand that no one employed by the Company (except the CEO) has any authority to offer employment on any other terms other than these.

I also understand and agree to the Company's policy that the Company's decisions on all employment matters are final, and are not subject to review or appeal outside the Company except as required by laws providing, or requiring employers to provide specific employment standards and rights.  In consideration of my employment by the Company, I agree to the above terms of employment.

Thank you for submitting your application.  We will be with you shortly.

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