Employment Application

Last Name: First Name: Middle Name:

Are you over age 18? Yes No Social Security Number (last 4 digits only): XXX-XX-

Street Address: City: State: Zipcode:

Cell Phone Number: Home Phone Number:

Position applying for:

Date Available: // (mm/dd/yy) How were you referred?

After employment can you submit verification of your legal right to work in the US? Yes No

Have you ever worked here before? Yes No Have you ever applied here before? Yes No

Shift Preference: 1 2 3 Are you willing to work overtime? Yes No Expected wage:

Have you ever been convicted of a crime? Yes No

Additional Comments:

Service Branch: Initial Rank: Final Rank:

Major Duties: Service School:

Honorable Discharge: Yes No

High School:

Name: City: State: Major:
Year Completed: 9 10 11 12 Diploma: Yes No

College:

Name: City: State: Major:
Years Completed: 1 2 3 4 Degree:

Other:

Name: City: State: Major:
Years Completed: Degree:

Other:

Name: City: State: Major:
Years Completed: Degree:

Are you pursuing a course of study now? Yes NoIf yes, enter subject:

Name and location of institution:

PCKind/Type: Years Experience:

Software ProgramsKind/Type: Years Experience:

EquipmentKind/Type: Years Experience:

Metal FabricationKind/Type: Years Experience:

CNC/MachinistKind/Type: Years Experience:

Can you read Blueprints? Yes No

Other - please specify any other skills, qualifications, or experience that you have with years of experience to be considered in job placement.

Please complete last ten years employment history even if supplemented by resume. Include military service and self employment. Account for all periods of unemployment.

Current or Most Recent Employer: Area Code/Telephone:

Address:

Supervisor's Name: May we contact your supervisor? Yes No

From: mm yyTo: mm yySalary/Wage Start: End:

Your Position and Duties:

Most liked about this job: Least liked:

Reason for leaving or considering a change at this time:

Previous Employer: Area Code/Telephone:

Address:

Supervisor's Name:

From: mm yyTo: mm yySalary/Wage Start: End:

Your Position and Duties:

Most liked about this job: Least liked:

Reason for leaving:

Previous Employer: Area Code/Telephone:

Address:

Supervisor's Name:

From: mm yyTo: mm yySalary/Wage Start: End:

Your Position and Duties:

Most liked about this job: Least liked:

Reason for leaving:

Previous Employer: Area Code/Telephone:

Address:

Supervisor's Name:

From: mm yyTo: mm yySalary/Wage Start: End:

Your Position and Duties:

Most liked about this job: Least liked:

Reason for leaving:

List three previous managers, supervisors or business associates (other than relatives) who know your qualifications.

Complete Name: Address and Work and/or Home Phone Numbers:

Position and Work Relationship: Company Affiliations:

Complete Name: Address and Work and/or Home Phone Numbers:

Position and Work Relationship: Company Affiliations:

Complete Name: Address and Work and/or Home Phone Numbers:

Position and Work Relationship: Company Affiliations:

By typing my name in the "Signature" field below I hereby certify that the answers given by me to the foregoing questions and statements are true and correct and hereby authorize Alcore, Inc. to verify same. If employment is obtained under this application I will comply with all orders, rules and regulations of the company. I also authorize my former employers and educational institutions to give any information they may have regarding me. I hereby release them and their organizations from all liability to any damage whatsoever for issuing same. If upon investigation, anything in this application is found either to be untrue or omitted or misrepresented, I understand that I may not be hired by Alcore, Inc. or may be subject to dismissal at any time during the period of employment, if hired. In consideration of my employment, I agree to conform to the rules and regulations of the Company and my employment and compensation can be terminated with or without cause, and with or without notices, at any time, at the option of either the Company or myself. I understand my employment (and the terms and benefits provided or paid to me) is not intended and does not constitute any contractual relationship.

Under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment or continued employment, that an individual submit to or take a lie detector or similar test, any employer who violates this law is guilty of a misdemeanor and subject to fine not exceeding $100.

Signature: Date:

It is the policy of Alcore, Inc. to provide equal employment opportunity to all qualified applicants for employment without regard to race, color, religion, national origin, sex, age, veteran status or disability. As an affirmative action employer under E.O. 11246, we invite all applicants to identify themselves as indicated below.

Completion of this form is voluntary and in no way affects the decision regarding your application for employment. This form is confidential and will be maintained separately from your application form.

Last Name: First Name: Middle Name: Date:

Position applied for (list only one):

Where did you hear about this job?

Racial Origin (You may mark one or more of the following)
White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
American Indian or Alaskan Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
Black or African American - A person having origins in any of the black racial groups of Africa.
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Ethnicity:
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Sex: Male Female

I decline to provide this information.

By typing my name in the "Signature" field below I hereby certify that the answers given by me to the foregoing Applicant Affirmative Action Information questions and statements are true and correct.

Signature: