Employment Application

Step 1 of 8

Position Applied For*
Shift Preferred*
- First
- Second
- Other
Date Available to Start Work
Personal Data
Name*
First Middle Last
Date*
Date Format: 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

References
List Three Business Related Individuals
Reference 1
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Occupation
Reference 2
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Occupation
Reference 3
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Occupation

Other Job-Related Experience
Some people gain job-related experience in positions other than as an employee. For instance, an accountant may gain experience as a treasurer of a civic or school organization, or a manager may gain experience while working on civic projects, or in school organizations, or in PTA activities. Please list and describe any paid or unpaid activities, honors, experience, or training that might aid you in performing the job(s) for which you have applied, and have not been listed previously in this application. (You may omit any activities, honors, memberships or other items that tend to identify your race, sex, national origin, age, disability or other personal traits that you prefer not to disclose.)
Please add any additional information (except that which identifies your race, color, religion, sex, national origin, age, disability, genetic information, citizenship, status as a Vietnam-era, special disabled veteran, or other veteran who served on active duty during a war, campaign, or expedition, for which a campaign badge has been authorized, in accordance with applicable federal laws) that you think may be relevant to a decision to hire you.
Please Read Carefully and Initial Each Paragraph Before Signing
Initial After Reading*
By my signature and initials, I promise that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment by Catalytic Combustion Corporation if discovered at a later date. I agree to immediately notify Catalytic Combustion Corporation if I should be convicted of a felony, or any crime involving dishonesty or a breach of trust while my job application is pending, or during my period of employment, if hired.
Initial After Reading*
I authorize any person, school, current employer (except as previously noted), past employer(s), government or investigative agencies, and other organizations that may be named in this application form (and accompanying resume, if any) to provide the company with relevant information and opinion that may be useful to Catalytic Combustion Corporation in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.
Initial After Reading*
I understand that, if hired, I may not hold other employment, nor engage in consulting, sales, investments or other activities that may create a conflict of interest with Catalytic Combustion Corporation.
Initial After Reading*
I understand that this application does not, by itself, create a contract of employment. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time. I understand that only the President of Catalytic Combustion Corporation is authorized to change any of the terms of employment and that any changes must be specific and in writing.
Name
First Last
Date
Date Format: MM slash DD slash YYYY
Upload Resume
Accepted file types: pdf, doc, docx, jpg, jpeg.

Invitation to Applicants to Self-Identify for Affirmative Action Purposes
This company prepares affirmative action plans that cover females, minorities, protected veterans, and individuals with disabilities. This survey is meant to help the company fulfill various objectives in these affirmative action plans. PLEASE NOTE: You are not required to complete any part of this form. Submission of this form is voluntary. The decision not to complete this form will not affect any opportunity for employment or any benefits with the company. Any information you provide in this survey will be kept confidential and will not be used in any way that may adversely affect your employment with this company.
Name
First Last
Date
Date Format: MM slash DD slash YYYY
Position you are applying for
How were you referred to the company?
Affirmative Action Related Data
Please check appropriate boxes
Gender
- Male
- Female
- Decline to Answer
Ethnicity
- Hispanic (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

Step 1 of 8

Personal Data

General Information

Education Data

High School

Technical, Vocational, Business or Military Training

College or University

Graduate School

Professional Seminars

Employment History

Present & Former Employers

Employment 1

Employment 2

Employment 3

Employment 4

Employment 5

Employment 6

References

Reference 1

Reference 2

Reference 3

Other Job-Related Experience

Please Read Carefully and Initial Each Paragraph Before Signing

Invitation to Applicants to Self-Identify for Affirmative Action Purposes

Affirmative Action Related Data

Time Period(s)	Reason(s) for Unemployment