Employment Application Employment Application THE FOLLOWING APPLICANT POLICY HAS BEEN ADOPTED BYThermalex, Inc.Applications will ONLY be accepted when there is an open position.All applicants must specify the job for which they are applying. Applicants may not indicate general categories such as “any job” on the application form. Applications are filed by job applied for; therefore, be specific in completing the “position applied for” section of the form.Applications will be held in the active file for 60 calendar days. After that time, if you still wish to be considered for the position(s) for which you have applied, you will need to complete a new application.Incomplete applications will not be considered and will be kept in a “dead” file for 60 calendar days. Although an applicant may submit a resume along with the application, the application form must be completed in its entirety for consideration.Unsolicited resumes will not be retained or considered.Thermalex, Inc. (“TMX”)is an equal opportunity employer and does not discriminate on the basis of sex, race, color, creed, national origin, age, religion, sexual orientation, gender identity, gender expression, veteran status, or disability in admission to, access to, treatment in, or employment in its programs and activities.Under the Americans with Disability Act (“ADA”), it is the responsibility of the applicant with a disability to request the accommodation that he/she requires in order to participate in the application process. TMX reserves the right to require documentation of the need for accommodation under the ADA. In order to request accommodation in the application process, contact Human Resources at (334) 420-6638.STATEMENT OF UNDERSTANDING AND AGREEMENT: I understand that the use of the application form does not indicate there are any positions open and does not in any way obligate Thermalex, Inc. I understand that, if hired, (a) I am required to abide by all rules and regulation of the Company; (b) the employment relationship between me and the Company has no specific term and is terminable at will either by me or by the Company, both during and after the initial probationary period. I agree to undergo a medical examination and to respond truthfully to medically related inquiries after an offer of employment has been made to me and prior to the commencement of any employment duties, and I understand that any offer of employment is conditioned on the results of such examination and inquiries (including a drug screen). I further agree, after employment, to be subjected to random and for cause drug screens.I certify that the information I have given on this application is true and complete and understand that in the event of employment, any false or misleading information given in my application or interviews may be cause for immediate dismissal without further notice regardless of the time of discovery.I hereby release TMX from all liability or responsibility all persons, schools, corporation, government agencies or other organizations furnishing information regarding my personal, employment and educational history; and hereby authorize the release of any such information including law enforcement records. Photocopies of this Authorization to Release Information should be treated as original. Thermalex, Inc. is not required to inform me of the specific reasons why either favorable or unfavorable action on my application has been made. I have read and understand this Statement of Understanding Agreement.ANSWER EACH QUESTION SO THAT YOUR QUALIFICATIONS CAN BE GIVEN EVERY CONSIDERATION. Name as your signature representing your agreement with the above statement.*FirstLast Date* UPLOAD RESUME You must still fill out this form even if you upload your resume for it to be submitted. Position Applied For * Salary Requirements Date Available For Work* Who referred you to us? Full Name*FirstLast Social Security Number* Address Street Address Street Address Line 2 City State Postal / Zip Code County* Telephone Number* Cell Phone/Other Phone If you are under 18 years of age, are you able to provide a work permit?*YesNo Have you ever been an employee of Thermalex?*YesNo If Yes, what department and position? Dates you worked as a Thermalex employee: Who referred you to Thermalex? Have any of your relatives ever worked for Thermalex?*YesNo If yes, who? Eligibility under the Immigration Reform Act of 1986 is required for employment. If hired, can you provide documentation of your identity and eligibility to work in the United States?*YesNoEDUCATION Choose the highest level of education completed:*3456789101112 DIploma?*YesNo GED?*YesNo Vocational Training?*YesNo If Yes, area of training: Highest Level of College Completed:*01234 Major and Minor?MajorMinor What Degree Completed? Highest Level of Graduate School Completed?*01234 Major and Minor:MajorMinor What Graduate School Degree Completed? LIST SPECIAL SKILLS AND QUALIFICATOINS RELEVANT TO THE POSITOIN FOR WHICH YOU APPLIED* EMERGENCY CONTACT INFORMATION*FirstLast RELATIONSHIP* CONTACT PHONE NUMBER* ALTERNATE PHONE NUMBEREMPLOYMENT HISTORYList jobs held in the last 10 years. Include military service and volunteer activities. Complete this section even if you submit a resume. EMPLOYER Present or Last: E1 SUPERVISOR'S NAMEFirstLast E1 ADDRESS Street Address Street Address Line 2 City State Postal / Zip Code E1 Phone Number E1 JOB TITLE E1 SHIFT TYPEFull TimePart Time E1 SALARYStartFinish E1 DATES EMPLOYED E1 DESCRIBE RESPONSIBILITIES: E1 REASON FOR LEAVING: E1 PRESENTLY EMPLOYEDYesNo E1 MAY WE CONTACT EMPLOYER TO OBTAIN A REFERENCE?YesNo E2 EMPLOYER E2 SUPERVISOR NAMEFirstLast E2 ADDRESS Street Address Street Address Line 2 City State Postal / Zip Code E2 PHONE NUMBER E2 JOB TITLE E2 SHIFT TYPEFull TimePart Time E2 SALARYStartFinish E2 DATES EMPLOYED E2 DESCRIBE RESPONSIBILITIES: E2 REASON FOR LEAVING E3 SUPERVISOR'S NAMEFirstLast E3 EMPLOYER E3 EMPLOYER ADDRESS Street Address Street Address Line 2 City State Postal / Zip Code E3 PHONE NUMBER E3 JOB TITLE E3 SHIFT TYPEFull TimePart Time E3 SALARYStartFinish E3 DATES EMPLOYED E3 DESCRIBE RESPONSIBILITIES: E3 REASON FOR LEAVING E4 EMPLOYER E4 SUPERVISOR'S NAMEFirstLast E4 ADDRESS Street Address Street Address Line 2 City State Postal / Zip Code E4 PHONE NUMBER E4 JOB TITLE E4 SHIFT TYPEFull TimePart Time E4 SALARYStartFinsh E4 DATES EMPLOYED E4 DESCRIBE RESPONSIBILITIES: E4 REASON FOR LEAVING: E5 EMPLOYER E5 SUPERVISOR'S NAMEFirstLast E5 ADDRESS Street Address Street Address Line 2 City State Postal / Zip Code E5 PHONE NUMBER E5 JOB TITLE E5 SHIFT TYPEFull TimePart Time E5 SALARYStartFinish E5 DATES EMPLOYED E5 DESCRIBE RESPONSIBILITIES: E5 REASON FOR LEAVING: E6 EMPLOYER E6 SUPERVISOR'S NAMEFirstLast E6 ADDRESS Street Address Street Address Line 2 City State Postal / Zip Code E6 PHONE NUMBER E6 JOB TITLE E6 SHIFT TYPEFull TimePart Time E6 SALARYStartFinish E6 DATES EMPLOYED E6 DESCRIBE RESPONSIBILITIES: E6 REASON FOR LEAVINGVoluntary Self-Identification Form EMPLOYEE NAME FOR IDENTIFICATION FORMFirstLast EMPLOYEE SOCIAL SECURITY NUMBER FOR IDENTIFICATION FORMThe following information is being gathered for compliance with federal regulations, and for bona fide occupational qualifications. It will be kept in a confidential file separate form the personnel file. Further, supervisors and managers may be informed regarding work restrictions of those with disabilities and the need for necessary accommodations.If you choose not to answer any of these questions, you will not be subject to adverse treatment. If you choose not to “self-identify,”however, we are required under Federal regulations to maintain sex, race and disability information on the basis of visual observation orpersonal knowledge. If you do not wish to furnish this information, please initial and date below. EMPLOYEE INITIALS FOR DECLINING INFORMATION DATE FOR DECLINING INFORMAITON GENDERMaleFemale RACEWhite - (Not of Hispanic origin) – All persons having origins in any of the original peoples of Europe, North Africa, or Middle EastBlack – (Not of Hispanic origin) – All persons having origins in any of the Black racial groups of Africa.Hispanic – All persons of Mexican, Puerto Rican, Cuban, Central or South America, or other Spanish culture or origin, regardless of race.Asian or Pacific Islander – All persons having origins in any of the original peoples from the Far East, Southeast Asia , the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands and Samoa.American Indian or Alaskan Native – All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. SPECIAL DISABLED VETERAN: Are you a special disabled veteran? A special disabled veteran means (1) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to compensation) under laws administered by the Department of Veterans’ Affairs for a disability (a) rated at 30% or more, or (b) rated at 10% or 20% in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap; or (2) a person who was discharged or released from active duty because of a service-connected disability.YesNo VIETNAM-ERA VETERAN: Are you a veteran of the Vietnam era? A veteran of the Vietnam era means a person who (i) served on active duty in the U.S. military, ground, naval or air service for a period of more than 180 days, and who was discharged or released there from with other than a dishonorable discharge, if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975, in all other cases; or (ii) was discharged or released from active duty in the U.S. military ground, naval or air service for a service-connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or (B) between August 5, 1964, and May 7, 1975 , in any location.YesNo NEWLY SEPARATED VETERAN: Are you a newly separated veteran? A newly separated veteran means any veteran who served on active duty in the U.S. military, ground, naval or air service during the one-year period beginning on the date of such veteran’s discharge or release from active duty.YesNo OTHER PROTECTED VETERANS: Are you part of ‘other protected veterans’? ‘Other protected veterans’ means any veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized. The criteria for identifying Other Protected Veterans is subject to change, as periods of service end and new campaign badges are added (please ask a Human Resources Representative for the list of criteria).YesNo DISABLED: Are you a disabled individual? A disabled individual means any person who (1) has a physical or mental impairment that substantially limits one or more major life activities; (2) has a record of such impairment; or (3) is regarded as having such an impairment.YesNoAnswer the following question only if you consider yourself to be handicapped/disabled: Do you require any accommodations to satisfactorily perform your position or the one for which you are applying?YesNo IF YES, PLEASE EXPLAIN: FINAL SIGNATURE*FirstLast Date SubmitReset
