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Employee Application

Packless Metal Hose, Inc. (dba Packless Industries) is an Equal Opportunity Provider and Employer and as such will not discriminate against any qualified employee or applicant because of race, color, religion, creed, sex, age, national origin, veteran’s status or disability.

Disability Accommodation: The Company will reasonably accommodate all applicants and employees with disabilities if the Company is informed of such disability. If you need accommodation during the application process, then notify the Human Resource office so reasonable accommodations can be provided.

This form is designed to help you find employment with our company by informing us of your qualifications. At the end of the application you may attach a resumé. Any information will be treated as a personal matter and kept confidential.

General Information

Name

First(Required)

Middle

Last(Required)

Personal Address

Street or PO Box(Required)

Apt #

City(Required)

State(Required)

Postal Code(Required)

Drivers License or State Issued ID

ID Number

Issuing State

Expiration Date

Phone Number

One form of contact is required. Please give us your cell phone number, home phone number, or both.

Cell

Home

Packless Connection

I was previously employed at Packless

Date Left

Supervisor's Name

Department Name

Names of friends or relatives currently employed by Packless

Work Availability (Please check all that apply)

Date available to work(Required)

Describe any special conditions that would affect the hours you could work

Education/Skills Information

High School/GED

I am a High School Graduate

I have a GED

Please list any education, certification/licenses or skilled training beyond high school.

School/Training #1

Name of School

Starting Date

Finishing Date

Degree of Certificate Earned

Field of Study

School/Training #2

Name of School

Starting Date

Finishing Date

Degree of Certificate Earned

Field of Study

School/Training #3

Name of School

Starting Date

Finishing Date

Degree of Certificate Earned

Field of Study

School/Training #4

Name of School

Starting Date

Finishing Date

Degree of Certificate Earned

Field of Study

Prior Experiences (Please check all that apply)

Brazing

Welding

Machine Operation

Industrial Maintenance

Military Service

I have served in the armed forces

Branch

Highest Rank

Date Entered

Date Discharged

MilitaryDuties

Personal References

Please provide information below for three (3) people that are not related to you and how you are acquainted (friend, neighbor, past employer/co-worker).

Personal Reference #1

Name of Reference(Required)

Years Acquainted(Required)

Phone Number(Required)

Acquaintance Description(Required)

Personal Reference #2

Name of Reference(Required)

Years Acquainted(Required)

Phone Number(Required)

Acquaintance Description(Required)

Personal Reference #3

Name of Reference(Required)

Years Acquainted(Required)

Phone Number(Required)

Acquaintance Description(Required)

Employment History Data

Start with your present or last job. Please include any job-related military service assignments.

Employer #1

Employer Name

Hire Date

Separation Date

Ending Salary

Phone Number

City

State

Job Title

Supervisor Name

Reason for Leaving

Summary of your job duties

Employer #2

Employer Name

Hire Date

Separation Date

Ending Salary

Phone Number

City

State

Job Title

Supervisor Name

Reason for Leaving

Summary of your job duties

Employer #3

Employer Name

Hire Date

Separation Date

Ending Salary

Phone Number

City

State

Job Title

Supervisor Name

Reason for Leaving

Summary of your job duties

Employer #4

Employer Name

Hire Date

Separation Date

Ending Salary

Phone Number

City

State

Job Title

Supervisor Name

Reason for Leaving

Summary of your job duties

Additional Information

Please use the space below to add any other information that you feel may assist us in our decision.

Extra Information

Upload Resumé (Optional)

File must be a PDF under 3 MiB.

Resumé

Applicant Authorization

Signature and Date

This certifies that this application was completed by me, and that all entries on it and information on it are true and correct to the best of my knowledge. I understand that satisfactory completion of a physical and other examinations are required as a condition of employment. I authorize by my signature below or a copy thereof on, investigation of my prior employment and background and of all statements contained in this application form. Packless Metal Hose, Inc. (dba Packless Industries) shall be held harmless for relying on information obtained from these sources, even if the information provided is inaccurate or erroneous. Further, I understand that misrepresentation or omission of facts called for is cause for my dismissal.

Additionally I understand that nothing contained in this employment application or in the granting of an interview or in any policies, procedures or handbooks that I might receive, is intended to create an employment contract between Packless Metal Hose, Inc. and myself. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Packless unless in writing and signed by the Vice President & General Manager.

If an employment relationship is established, I understand that Packless Metal Hose, Inc.'s rules, regulations, policies, and information outlined in the handbook or elsewhere are not a contract and may be changed, amended or waived by Packless Metal Hose, Inc. at any time. I also understand that I will be an employee at will and that I have a right to terminate my employment at any time, for any reason or for no reason, and Packless Metal Hose, Inc. likewise retains the same right to terminate my employment at any time, with our without notice or cause.

Signed(Required)

Date Signed

Fluid Heat Transfer Coils

Employment Application

Employee Application

General Information

Education/Skills Information

Please list any education, certification/licenses or skilled training beyond high school.

Personal References

Employment History Data

Additional Information

Applicant Authorization