Valco Industries Job Board

Applicant Information

Name *

First

Last

Phone *

Social Security #

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

POSITION & WORK AUTHORIZATION

Checkboxes

Full Time
Part Time
Temporary
Internship

Desired Salary/Hourly Wage:

Desired Shift

First
Second
Either

Are you 18 years or older?

Yes
No

Are you legally authorized to work in the United States?

Yes
No

Are you able to perform the essential functions of the job you are applying for, with or without reasonable accommodation?

Yes
No

Have you ever applied for employment with Valco or worked for Valco before?

Yes
No

Do you have relatives that work at Valco?

Yes
No

Names of relatives that work at Valco Industries:

Have you ever been disciplined, suspended, or terminated from employment within the last 10 years?

Yes
No

If yes, explain the nature, date and location of disciplinary action:

How many regularly scheduled work days did you miss last year (excluding any FMLA leave):

PREVIOUS EMPLOYMENT

List all present and past employment

United State Military or Reserves Branch:

Dates:

Rank at Discharge:

Employer #1

Company:

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor:

Supervisor Phone:

Job Title:

Starting Wage $

Ending Wage $

Responsibilities:

Employed From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

Employer #2

Company:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor:

Supervisor Phone:

Job Title:

Starting Wage $

Ending Wage $

Responsibilities:

Employed From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

Employer #3

Company:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor:

Supervisor Phone:

Job Title:

Starting Wage $

Ending Wage $

Responsibilities:

Employed From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference?

Yes
No

HIGH SCHOOL

Name & Location:

Years Attended:

Degree:

Did You Graduate?

Yes
No

Did You Graduate?

Yes
No

COLLEGE

Name & Location:

Years Attended:

Degree:

Did You Graduate?

Yes
No

Did You Graduate?

Yes
No

TRADE / OTHER

Name & Location:

Years Attended:

Degree:

Did You Graduate?

Yes
No

Did You Graduate?

Yes
No

Please list any special achievements, honors, certifications, professional licenses, or special technical skills which you feel may be useful as we review you as a candidate for employment:

REFERENCES

Name:

Company:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Relationship:

Phone Number:

Name:

Company:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Relationship:

Phone Number:

Name:

Company:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Relationship:

Phone Number:

APPLICATION

I certify that this Application for Employment was completed by me, and that all entries on it are true and complete to the best of my knowledge. I understandthat Valco Industries, Inc. (“Valco”) may terminate my employment for any false or misleading statements or omissions in this application, in any interviewor otherwise in the application or hiring process, whenever they may be discovered. I further agree to furnish any additional information and complete any applicable examinations as may be required to complete my employment file.
I understand that completion of this application does not necessarily indicate that there are any positions open now and does not in any way obligate either me or Valco. This application will be kept active for 60 days from the date of its completion, after which it will not be considered. Incomplete applications will not be considered.

COMPANY POLICY

In consideration of my employment, I agree to adhere to the expectations, regulations and policies of Valco. I understand that, if I accept employment with Valco, it will be employment at will, which means that either the Company or I have the right to terminate the employment relationship at any time, for any reason, with or without cause or notice.
I understand that all new employees must comply with the verification requirements of the Immigration Reform and Control Act. I further understand that if I am hired, I will be required, within three days of starting work, to provide documents proving my identity and authorization to work in the United States. I understand that, consistent with Valco’s policies and the law, any handicapped applicant who wishes to identify him or herself may be entitled to reasonableaccommodation. I understand that this information is confidential and will be used only for appropriate purposes and that opting to or not to provide suchinformation will not adversely affect an application

PRE-EMPLOYMENT DRUG SCREEN AGREEEMENT

Because Valco is a Drug-Free Workplace, I acknowledge that a condition of employment is satisfactory completion of a body substance drug test. I understand that if I receive an offer of employment, Valco’s policy will require me to submit a body substance sample for drug testing. I further understand the purpose of this analysis is to determine or rule out the presence of non-prescribed or prohibited dangerous controlled substances in my system. Should this occur, I freely and voluntarily consent to this requires for a body substance sample, and I release the company, its employees, agents and contractors from any and all liability whatsoever arising from this request for testing, from the actual testing procedures and from decisions made concerning my application for or continuation of employment based on the results of the analysis. I authorize the release of my drug and/or alcohol test results to Valco’s medical reviewofficer, and/or examining physician, as provided by the policy.

I understand that refusal to submit a body substance sample shall constitute failure to apply or withdrawal of application and will prevent me from being employed.

BACKGROUND CHECK & DISCLOSURE OF CONSUMER REPORT / INVESTIGATIVE CONSUMER REPORT UNDER THE FAIR CREDIT REPORTING ACT

In connection with my application for and with my employment, I understand that Valco may obtain or cause to be prepared consumer reports for employment purposes. It may be an investigative consumer report which is obtained through personal interviews and might include information as to my character, general reputation, personal characteristics, work habits, performance, experience, and mode of living. I understand that as directed by company policy and consistent with the job described Valco may request information from public and private sources about my driving record, court record, education, credentials, and past employment.
I authorize Valco to obtain or cause to be prepared consumer reports, and investigative consumer reports, about me for employment purposes. I understand that in obtaining such consumer reports and investigative consumer reports, a consumer reporting agency may be used, and I authorize such use. I authorize any law enforcement agency, institution, information service bureau school, employer, reference or insurance company contacted by Valco or its agent, tofurnish the information described above. I release Valco, its employees and agents, and all personals and entities furnishing above-mentioned information and reports about me from any and all liability of any type as a results of furnishing or obtaining such information and for any damages on account of furnishing or obtaining such information. I understand that I may make a written request, within a reasonable period of time, for a disclosure of the nature and scope of any investigative consumer report Valco has requested. I may also request a written summary of my rights under the Fair Credit Reporting Act.

AUTHORIZATION TO RELEASE INFORMATION

In connection with my application for and with my employment, I understand that Valco may obtain certain public and private, oral and written information about me, my credentials and my academic and job performance from information providers including, but not limited to, schools and previous employers (“Providers”).
I authorize Providers, including schools and previous employers and any of their employees, to share with Valco (or any of its representatives or consultants) any and all information about me, whether written or oral, which may include but shall not be limited to, information related to academic and/or jobperformance, discipline, or attendance (collectively, “Information”). I hereby waive any right to written notice from the Providers prior to their disclosure of Information to Valco. I hereby release the Providers, Valco and its agents, representatives, consultants, and employees from any and all known and unknown legally waivable claims, causes of action, or similar rights of any type arising under federal, state, or local law (“Claims”) relating to the disclosure ofInformation to Valco or its representatives or consultants, including but not limited to, Claims that the disclosures caused me any harm.
I agree to never bring any action or proceeding against any Provider, Valco, or its agents, representatives, consultants or employees based on or relating tothe disclosure of Information pursuant to this Authorization to Release Information.

SIGNATURE FOR ALL OF THE ABOVE RELEASES

I understand that my application will not be processed until it is completed and signed.
This authorization, certification and disclosure will remain effective for the duration of my employment, if I am hired.
I authorize that I am signing of my own free will and that I have had a reasonable amount of time to consider whether to sign it.

Name: (Print Signature) *

First

Last

Date: *

What three (3) things do you like best about your current/most recent job?

What three (3) things do you like least about your current/most recent job?

If you could change three (3) things about your current/most recent job, what would they be?

What do you expect from an employer?

What do you think is reasonable for an employer to expect from you? (i.e., what do you think a company should get from you for the wages it pays you?)

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