APPLICATION FOR EMPLOYMENT

THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT, but merely is intended to evaluate suitability for employment. It is the policy of Artistic Carton Company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, sexual preference, national origin, citizenship, disability, veteran status or any other status protected under state and federal law. It is also the policy of Artistic Carton Company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon a successful completion of a medical examination, which may include providing body substance samples. You are also advised that (1) Artistic Carton Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such a policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such a policy.

For which facility are you applying?

Auburn, IN  Elgin, IL

Name

First	Middle	Last

Address

Line 1
Line 2
City	State Zip

Telephone Social Security #

Email Address

Are you under 18 years of age? No Yes

Have you ever been convicted of a felony? No Yes

If yes, please give where, when, nature of offense and type of rehabilitation


Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? No Yes
(proof of citizenship or immigration status will be required upon employment)

List any friends or relatives that are working here


Have you worked here before? If so, when?


If you are employed now, may we contact your present employer? No Yes

On what date would you be available to work?

Shift Preference - enter Shift 1, Shift 2 and Shift 3 in order of preference

Preference 1

Preference 2

Preference 3

Are you available to work Full-Time Part-Time Shift Work Temporary

Are you on a lay-off subject to recall? No Yes

Education

High School

Name Location

Years Completed Course of Study

Diploma/Degree

College

Name Location

Years Completed Course of Study

Diploma/Degree

Graduate School

Name Location

Years Completed Course of Study

Diploma/Degree

Vocational/Training

Name Location

Years Completed Course of Study

Diploma/Degree

Employment Experience

Employer Address Job Title Supervisor	Starting Date Ending Date	Starting Pay Ending Pay
	Work Performed
Reason for Leaving

---

Employer Address Job Title Supervisor	Starting Date Ending Date	Starting Pay Ending Pay
	Work Performed
Reason for Leaving

---

Employer Address Job Title Supervisor	Starting Date Ending Date	Starting Pay Ending Pay
	Work Performed
Reason for Leaving

---

Employer Address Job Title Supervisor	Starting Date Ending Date	Starting Pay Ending Pay
	Work Performed
Reason for Leaving

---

Special Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experience


Have you ever been warned, disciplined or discharged for sexual harassment, fighting, assault, use of or reporting to work under the influence or any illegal substance and/or alcohol?
No Yes

If so, please please provide a detailed explanation of the circumstances, place of employment, date and resolution


Have you ever been warned, disciplined or discharged for violating a safety rule?
No Yes

If yes, please give where, when, nature of offense and type of rehabilitation