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GENERAL INFORMATION

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP

Contact Number*

Email*

Are you legally authorized to work in the United States?*

Do you now, or will you in the future, require immigration sponsorship for work authorization (e.g., H-1B)?*

(If hired, verification will be required consistent with federal laws.)

POSITION INFORMATION

Type of position:*

Factory

Office

Seasonal

Preferred shift?

Any

1st

2nd

3rd

Position applied for:

Salary

Negotiable

I have a desired salary range

Salary/hourly range expected:*

Per:*

Have you worked for The Wooster Brush Company before?*

What was your position?*

BACKGROUND INFORMATION

During the past seven years, have you ever been discharged, suspended, or asked to resign from any position?*

Please explain*

For the purpose of verifying information on this application, have you ever worked or attended school under a different name at any of the organizations you have listed?*

Specify different name used*

Have you ever been convicted of a crime (not traffic violations) that has not been expunged, sealed, pardoned, annulled, statutorily eradicated, or dismissed upon condition of probation? (Please note: You are not required to disclose sealed or expunged records of conviction or arrest or expunged juvenile records of conviction or arrest.)*

Please explain*

EDUCATION INFORMATION

HIGH SCHOOL OR GED EQUIVALENT

School Name & Location*

Highest Grade Completed*

COLLEGE OR UNIVERSITY

School Name & Location

Degree

Major

GRADUATE SCHOOL

School Name & Location

Degree

Course of Study

OTHER (INCLUDING MILITARY TRAINING)

Please provide details

Please comment on any specific experiences, skills, or licenses you have that you feel qualify you for employment with our Company

EMPLOYMENT HISTORY

List all employment experience for the past seven years, starting with the most recent or present employer, including U.S. Military Service. Using a separate section for each position, describe in detail all work experience including periods of unemployment. Please note: you may include, as part of your employment history, any verified work performed on a volunteer basis. Resumes may not be substituted in lieu of completing the following employment information.

POSITION 1:

Current Employer

This is my current employer

Employer*

Job Location*

Your Position*

Supervisor's Name/Title*

May we contact your supervisor?*

Why?*

Primary Responsibilities*

Employer Phone*

Start Date:*

End Date:*

Starting Rate

Last Rate

Reason for leaving*

POSITION 2:

Employer

Job Location

Your Position

Supervisor's Name/Title

May we contact your supervisor?

Why?

Primary Responsibilities

Employer Phone

Start Date:

End Date:

Starting Rate

Last Rate

Reason for leaving

POSITION 3:

Employer

Job Location

Your Position

Supervisor's Name/Title

May we contact your supervisor?

Why?

Primary Responsibilities

Employer Phone

Start Date:

End Date:

Starting Rate

Last Rate

Reason for leaving

Have you signed or otherwise agreed to any non-solicitation, non-competition, or other similar agreement with any prior employer?*

Please explain*

Please explain any gaps in employment

PERSONAL REFERENCES

List three references (not relatives) that we may contact:

REFERENCE 1:

Name*

Relationship*

Phone*

Email

REFERENCE 2:

Name*

Relationship*

Phone*

Email

REFERENCE 3:

Name*

Relationship*

Phone*

Email

Please list any relatives or friends that work, or have worked, at The Wooster Brush Company:

PLEASE READ CAREFULLY BEFORE SUBMITTING

Terms and Conditions*

I have disclosed all information that is relevant and should be considered applicable to my candidacy for employment.

I understand an offer of employment may be subject to and conditioned upon a satisfactory background check, pre-employment physical exam, and a drug and alcohol test.

I hereby certify that the information given by me is true and complete, and I understand that any falsification or omission of information may disqualify me from further consideration for employment, or if hired, may result in termination regardless of the time elapsed before discovery. I authorize The Wooster Brush Company and its representatives to contact my prior employers and all others (with the exception of my current employer, if I selected no in response to may we contact) for the purposes of verification of the information I have supplied and release the same from any liability resulting from the information released. I authorize employers, schools, and other persons named on this application to provide any information or transcripts requested.

I hereby certify that, if employed, my employment with The Wooster Brush Company will not conflict with, or result in the violation of, breach of, or default under any contract, agreement, or understanding that I am a party to or am bound by, other than those I have disclosed in this application.

I hereby certify that, if employed, I will promptly report to my supervisor, a representative of Human Resources, or other member of management, if I ever believe that I have been harassed in violation of Company policy or if I ever become aware of any unethical behavior by an employee.

I expressly understand and agree that, if employed, my employment, having no specific term, is based upon mutual consent and may be terminated at will, with or without cause, by either party without prior notice to the other, unless otherwise prohibited by law.

I understand that no representation, whether oral or written, by any representative or agent of The Wooster Brush Company, at any time, can constitute an implied or express contract of employment. I further understand no representative or agent of The Wooster Brush Company has the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms of conditions of employment other than in a document signed by the President of the Company or an authorized representative and myself.

I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.*

GENERAL INFORMATION

POSITION INFORMATION

BACKGROUND INFORMATION

EDUCATION INFORMATION

HIGH SCHOOL OR GED EQUIVALENT

COLLEGE OR UNIVERSITY

GRADUATE SCHOOL

OTHER (INCLUDING MILITARY TRAINING)

EMPLOYMENT HISTORY

POSITION 1:

POSITION 2:

POSITION 3:

PERSONAL REFERENCES

REFERENCE 1:

REFERENCE 2:

REFERENCE 3:

PLEASE READ CAREFULLY BEFORE SUBMITTING

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