Employment Application - Catalytic Combustion Corporation

Position Applied For*

Shift Preferred*

First

Second

Other

Date Available to Start Work

Personal Data

Name*

First Middle Last

Application Date*

MM slash DD slash YYYY

Address*

Street Address City State ZIP Code

Primary Phone*

Secondary Phone

Email Address*

Referred by

Our Advertisement

Friend or Relative

General Information

1. Have you ever applied for a job with this company in the past?*

Yes

If yes, please give the date of application and the position for which you applied. State your name at that time, if different from present name.

2. Have you ever been employed by this company in the past?*

Yes

If yes, please give dates of employment, position held, and state your name while employed if different from present name.

3. If hired, will you be able to work during the normal days and hours required for the position(s) for which you are applying?*

Yes

If no, please explain

4. Do you have any commitments to another employer that might affect your availability for employment with our company?*

Yes

If yes, please explain

5. If hired, can you furnish proof that you are 18 years of age, or if under 18, do you have a permit to work?*

Yes

If no, please explain

6. If hired, can you furnish proof that you are eligible to work in the United States? (If unsure of the documents needed to prove eligibility to work in the U.S., we will be happy to explain the legal requirements.)*

Yes

If no, please explain

7. Do you now, or will you in the future, require Catalytic Combustion Corporation to sponsor an employment visa for your continued employment?*

Yes

8. Have you been convicted of a felony, or released from prison in the past 10 years? Note: A yes answer does not automatically disqualify you from employment since the nature of the offense, date, and type of job for which you are applying will be considered.*

Yes

If yes, please explain

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

Yes

If yes, please explain

10. Are you charged with an unresolved criminal charge (have you been charged with a crime that has not yet resulted in a plea of guilty, court trial, or dropping of the charge)? Note: A yes answer will not automatically disqualify you from employment.*

Present & Former Employers

List Present or Most Recent Employer First – Please complete even if a resume is attached. Attach additional sheet if necessary.

Employment 1

Company Name

Date Began

Date Ended

Address

Street Address City State ZIP Code

Your name when employed, if different from present

Supervisor

Supervisor Phone

Job Titles & Duties

Reason for Leaving

Final Salary

May We Contact?

Yes

Employment 2

Company Name

Date Began

Date Ended

Address

Street Address City State