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Employment Application

Employment Application

Employment Application

Pre-Employment Drug and Alcohol Testing is Required

Position

Personal Data

Address

Phone

How/where did you hear about this job opening

General Information

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

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

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

Please give the dates of employment, position held, and state your name while employed if different from present name

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

Please explain

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

Please explain

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

Please explain

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.)

Please explain

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

Please explain

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

Please explain

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 does not automatically disqualify you from employment.

Please explain

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

Please explain

Education Information

High School

Name of School, Location and Highest Grade Completed

Did you Graduate

Further Education

Remove Education

Higher Education Type

Name of School and Location

Did you Graduate

Degree/Diploma/Certificate?

Major Course of Study

Add To Education History

Job Related certificates, licenses, equipment qualified to operate, computer hardware and software operated, and other Job-related special skills and abilites

Employment History Present & former employers

List present of most recent employer first - click the button below to add additional employment history.
Remove Employment

Previous Employer:

 

Address

Supervisor

Salary Info

per

Job Titles & Duties

Reason for Leaving

May We Contact?
Remove Employment

Previous Employer:

 

Address

Supervisor

Salary Info

per

Job Titles & Duties

Reason for Leaving

May We Contact?
Remove Employment

Previous Employer:

 

Address

Supervisor

Salary Info

per

Job Titles & Duties

Reason for Leaving

May We Contact?
Add To Employment History

Please account for any time you were not employed after leaving school in the past ten years (You need not list any unemployment periods of one month or less).

References

Reference 1:

Name

Address

Reference 2:

Name

Address

Reference 3:

Name

Address

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, origin, 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.

IMPORTANT

Please read carefully and initial each paragraph before signing.


Initials

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.
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.
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.
I understand that if employed and my employment id terminated by Catalytic Combustion Corporation for dishonesty, breach of trust, or any criminal acts, the authorities may be notified and I may be criminally prosecuted.
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.

Affirmative Action Survey (Optional)

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 of these affirmative action plans.

PLEASE NOTE: You are not required to complete any part of this form. 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.

Gender
Ethnicity
Race

Protect Veteran

If you believe you belong to any of the categories of protected veterans listed below, please indicate by checking the appropriate box. As a government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Protected Veteran Categories:

Disabled Veteran - A disabled veteran is one of the following: (a) 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 Secretary of Veterans Affairs or (b) a person who was discharged or released from active duty because of a service connected disability.

Recently Separated Veteran - A recently separated veteran is a veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

Active Wartime Or Campaign Badge Veteran - An active duty wartime or campaign badge veteran is a 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 under the laws administered by the Department of Defense.

Armed Forces Service Medal Veteran - An armed forces service medal veteran is a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Veteran Status

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.

How do I know if I have a Disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Disabilities include, but are not limited to:

  • Blindness
  • Autism
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Deafness
  • Cerebral palsy
  • Major depression
  • Obsessive compulsive disorder
  • Cancer
  • HIV/AIDS
  • Multiple sclerosis (MS)
  • Impairments requiring the use of a wheelchair
  • Diabetes
  • Schizophrenia
  • Missing limbs or partially missing limbs
  • Intellectual disability (previously called mental retardation)
  • Epilepsy
  • Muscular dystrophy
Do you have a disability?

Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Call for More Information: (715) 568-2882 | (888) 285-5940