Join Our Team

Name: *

First

Last

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Phone: *

Email: *

Do you have means of reliable transportation to get to work: *

Yes
No

Expected Hourly Rate : *

Are you legally eligible for employment in this country: *

Yes
No

(Proof of U.S. citizenship or immigration status will be required upon employment)

Employment Data

Are you seeking: *

Why are you seeking employment at this time: *

Are you available to work overtime: *

Yes
No

Are you able to travel if a job requires it: *

Yes
No

What position(s) are you applying for: *

Are you currently employed: *

Yes
No

If currently employed, when would you be available for work:

Have you ever been employed by Vermod: *

Yes
No

If Yes, when:

Where did you hear about this position: *

Work History

Please list your last 2 employers (3 if applicable), starting with the most recent.

Employer #1: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor: *

From: *

To: *

Title/Position: *

Work Performed: *

Reason for Leaving: *

May we contact this employer: *

Yes
No

Employer #2: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor: *

From: *

To: *

Title/Position: *

Work Performed: *

Reason for leaving: *

May we contact this employer: *

Yes
No

Employer #3:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor:

From:

To:

Title/Position:

Work Performed:

Reason for leaving:

May we contact this employer:

Yes
No

Education

Highschool: *

Address: *

Address Line 1

City

State

# of Years Attended: *

Graduate: *

Yes
No

Did you attend College or Graduate School: *

Yes
No

College:

Address:

Address Line 1

City

State

# of Years Attended:

Major Course and Degree:

Graduate:

Yes
No

Graduate School:

Address:

Address Line 1

City

State

# of Years Attended:

Major Course and Degree:

Graduate:

Yes
No

Certifications:

CPT Safety
CPT Quality
CPT Production
CPT Maintenance Awareness

Other Certifications:

Other Training or Skills:

Military Service

Are you a Veteran: *

Yes
No

From:

To:

List any special skills or training:

References

List three persons who are not relatives, employers or otherwise mentioned in this application, even if provided with your resume.

Reference #1: *

First

Last

Phone: *

How do you know this person: *

Reference #2: *

First

Last

Phone: *

How do you know this person: *

Reference #3: *

First

Last

Phone: *

How do you know this person: *

List any professional, trade, business or civic activities and office held:

You may exclude memberships which would review sex, race, religion, national origin, age, ancestry, or disability or any other protected status.

Indicate any foreign languages you can speak, read and/or write:

Review

*Please read the following paragraphs before submitting this application. Checking these boxes constitutes your agreement thereto in return for the consideration of your application.

Statement 1: *

I authorize Vermod (the “company”) to verify all statements contained on this application. I also authorize the company to contact my present employer, past employers, references, schools and organizations. I authorize any person, school, employer, or organization to provide the company with information and opinion and release the company and all such sources from any liability arising from the solicitation or use of the information.

Statement 2: *

I state that the information provided on this employment application and on my resume, if any, is true and complete and that there is no information which i have omitted or failed to include.

Statement 3: *

I agree that any false information or omissions, intentional or unintentional, on this employment application will disqualify me from consideration from employment and, if employed, may result in immediate discharge.

Statement 4: *

I agree that any false information or omissions, intentional or unintentional, on this employment application will disqualify me from consideration from employment and, if employed, may result in immediate discharge.

Please upload your resume:

Click or drag files to this area to upload. You can upload up to 2 files.

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Vermod Employment Application

Employment Data

Work History

Education

Military Service

References

Review