Application for Employment

Metal-Fab, Inc.
3025 May Ave.
PO Box 1138
Wichita, KS 67201-1138
P. 316.943.2351
F. 316.943.2717
j.o.b.s.@.m.t.l.f.a.b...c.o.m
An Equal Opportunity Employer
Conditions of employment are stated at the end of this form. Please read carefully before you submit this application.
(Application must be completed in full)
POSITION APPLIED FOR:
DATE OF APPLICATION:
07-02-2009
REFERRED BY METAL-FAB EMPLOYEE:
PERSONAL
FIRST NAME:
MIDDLE NAME: LAST NAME:
PRESENT ADDRESS -
STREET: CITY: STATE: ZIP:
HOME PH#: CELL PH#:
WORK PH#: PAGER/OTHER#:
IF NO PHONE, HOW MAY WE CONTACT YOU?:
HAVE YOU EVER WORKED FOR METAL-FAB BEFORE? NO - YES -
IF YES, APPROXIMATE DATE: MONTH/YEAR:
GENERAL INFORMATION
ARE YOU AT LEAST 18 YEARS OF AGE? YES NO DATE OF BIRTH:
ARE YOU ELIGIBLE FOR EMPLOYMENT IN THE UNITED STATES? YES NO
(if offered employment, you will be required to provide documentation to verify eligiblity.)
HAVE YOU BEEN CONVICTED OF A CRIME IN THE PAST SEVEN YEARS? YES - NO -
IF SO, PLEASE DESCRIBE IN THE BOXES BELOW.
Applicant is not obligated to disclose any reference to a pre or post trial diversion program, any conviction which has been sealed, expunged or erased by the court. Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at the time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewd.
INCIDENT
 CITY/STATE CHARGE
1.
2.
HAVE YOU EVER BEEN DISCHARGED FROM ANY EMPLOYMENT OR ASKED TO RESIGN? YES NO
IF YES, PLEASE EXPLAIN:
PLEASE CHECK SCHEDULE AVAILABILITY: FIRST SHIFT SECOND SHIFT THIRD SHIFT
Note: work schedules are based upon the needs of the business and may be subject to change.
WAGE EXPECTED: DATE AVAILABLE FOR WORK?
EDUCATION
EDUCATION
TYPE OF SCHOOL 		NAME OF SCHOOL
 MAJOR SUBJECT
GRADUATED
YES-----NO
MONTH/YR
HIGH SCHOOL
--
CITY/STATE
HIGH SCHOOL
--
CITY/STATE
COLLEGE
--
CITY/STATE
COLLEGE
--
CITY/STATE
VOCATIONAL
--
CITY/STATE
VOCATIONAL
--
CITY/STATE
OTHER TRAINING
--
CITY/STATE
ADDITIONAL EXPERIENCE OR QUALIFICATIONS
List any other experience, skills or other qualifications including hobbies, which you believe should be considered in evaluating your qualifications for employment. Please indicate any prior military service, which you would like to have considered in your application for employment.
JOB FUNCTIONS
Are you aware of any reason you cannot perform the functions of the job for which you are appyling? YES NO
If Yes, describe such reasons.
SKILLS
Check the skills or abilities you have which may be applicable to the position you are seeking.
CNC Machine Nail Gun Pallet Jack Filing Supervisor Skills
MIG/TIC Welding Grinder Housekeeping Counting Basic Computer
Decoiler Bender Conveyor Fax/Copy/Shred MS Word
Spot Welding Bander Electrical Facility Maint. Excel
Forklift Shear Measuring Tls Bilingual Comm.    
Press Machine Assembly Scanner Powerpoint    
Laser Skill Saw Data Entry Multi-Line Phone    
Sander Other Saw Typing Math Skills    
ATTENDANCE AND PUNCTUALITY INFORMATION
Consistent attendance and punctuality are essential requirements of every job with this company. Is there anything, which would interfere with your regular attendance and punctuality if you were offered a job with the company?
YES
NO
  
If Yes, please explain.
EMPLOYMENT HISTORY
List all jobs and activities including military service, school, part time employment while in school, self-employment and periods of unemployment. Begin with the most recent.
1.
NAME OF COMPANY:
FROM: TO:
ADDRESS:
CITY,STATE, ZIP:
PHONE#:
FAX#:
POSITION/TITLE:
ENDING SALARY$:
DESCRIPTION OF DUTIES:  
NAME & TITLE OF IMMEDIATE SUPERVISOR:
REASON FOR LEAVING - QUIT DISCHARGED
PLEASE EXPLAIN:
2.
NAME OF COMPANY:
FROM: TO:
ADDRESS:
CITY,STATE, ZIP:
PHONE#:
FAX#:
POSITION/TITLE:
ENDING SALARY$:
DESCRIPTION OF DUTIES:  
NAME & TITLE OF IMMEDIATE SUPERVISOR:
REASON FOR LEAVING - QUIT DISCHARGED
PLEASE EXPLAIN:
3.
NAME OF COMPANY:
FROM: TO:
ADDRESS:
CITY,STATE, ZIP:
PHONE#:
FAX#:
POSITION/TITLE:
ENDING SALARY$:
DESCRIPTION OF DUTIES:  
NAME & TITLE OF IMMEDIATE SUPERVISOR:
REASON FOR LEAVING - QUIT DISCHARGED
PLEASE EXPLAIN:
BUSINESS REFERENCES
NAME:
OCCUPATION:
TITLE:
RELATIONSHIP:
HOW LONG KNOWN:
HOME PHONE:
BUSINESS PHONE:
HOME ADDRESS:
CITY, STATE, ZIP:
NAME:
OCCUPATION:
TITLE:
RELATIONSHIP:
HOW LONG KNOWN:
HOME PHONE:
BUSINESS PHONE:
HOME ADDRESS:
CITY, STATE, ZIP:
CERTIFICATION AND RELEASE
PLEASE READ BEFORE SIGNING
I CERTIFY THAT ALL ANSWERS BY ME ARE TRUE, ACCURATE AND COMPLETE, AND I UNDERSTAND THAT FALSIFICATION, OMISSIONS, OR MISREPRESENTATIONS OF FACTS CALLED FOR IN THIS APPLICATION OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR HOW DISCOVERED.

Questions regarding this statement should be directed to any employment interviewer before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

As an equal opportunity employer, Metal-Fab, Inc. abides by applicable non-discrimination laws and will not unlawfully discriminate against any employee or applicant for employment because of race, color, age, sex, religion, national origin, ancestry, Vietnam era Veteran status, or disability. The Age Discrimination in Employment Act prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age. The Kansas Act Against Discrimination prohibits discrimination on the basis of age with respect to individuals who are at least 18 years of age.

I authorize Metal-Fab, Inc., its employees and agents to verify any information contained in this application or any other accompanying and or required documents. I release Metal-Fab, Inc., its employees and or agents and anyone from all liability for supplying such information for any damage or claim that may result from furnishing the information to Metal-Fab, Inc.

Metal-Fab, Inc. is a Drug Free Workplace and has zero tolerance for illicit drugs or alcohol.

If I am employed by Metal-Fab, Inc., I hereby acknowledge that Metal-Fab, Inc. may request a test for the detection of illicit drugs or for alcohol. I hereby consent to such a test, and authorize the laboratory that performed such sample and testing to inform Metal-Fab, Inc. of the results of the test. I consent to a Physical Capacity Test and authorize the Clinic that performed the testing to inform Metal-Fab, Inc. of the results of the test.

Employment at Metal-Fab, Inc. is also contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.

If hired, I agree to abide by the rules, regulations and policies of Metal-Fab, Inc. now in force or that may be established in the future, and I agree to conduct myself in accordance with them, with full knowledge that violation may mean discipline, including discharge. I understand that employment with Metal-Fab, Inc. is on an “at will” basis and my employment may be terminated with or without cause, and with or without notice at any time, at the option of either the Company or me. I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. No representative or agent of the Company, has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the President, or to make any agreement contrary to the foregoing.

I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me. If I am submitting the Application for Employment online, I agree to the terms of the Certification and Release and agree to sign the Certification and Release at the initial interview if I am selected for an interview.

APPLICANT SIGNATURE: DATE: