Employment Application

Personal Information
		*Fields with () are required.**
Name: (Last name first)*:		Today’s Date:
Present Address:	City:	State:	Zip:
Phone Number*:	Email Address*:	Are you authorized for employment in the United States? Yes No
Have you ever worked at Korns Galvanizing before: Yes No If yes, when:		Do you have any friends or relatives employed at Korns? Yes No
How did you hear about Korns?
Employment Desired
Position Applying for:		Are you available to work all shifts? Yes No If NO, specify your availability (check all that apply): Morning Afternoon Night Weekend
Date you can start:		Salary Desired:
Education History
Name and location of school		Years attended	Did you graduate?
High school			Yes No
College			Yes No
Trade School			Yes No
List any skills or training that you believe are applicable to the position applied for:
Employment History
Dates(from-to)	Name and Address	Duties	Reason for leaving



Do you have a valid Pennsylvania Driver’s License? Yes No
Have you ever been convicted of a crime? [Your answer to this question does not disqualify you from employment] Yes No
If offered employment, are you willing to consent to a criminal background check and drug screen? Yes No
Additional Comments:
PLEASE READ THIS STATEMENT CAREFULLY I hereby affirm that the information given by me on this application for employment is complete and accurate, to the best of my knowledge. I understand that any falsification or omission will be immediate grounds for dismissal. I authorize a thorough investigation to be made in connection with this application concerning my character, general reputation, employment, education background and criminal record, whichever may beapplicable. I understand that this investigation may include, and I hereby authorize the release of documents, and personal interviews with third parties, such as prior employers, family members, business associates, financial sources, friends, neighbors or others with whom I am acquainted. I further understand that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of the nature and scope of the investigation.It is understood that, as a condition of initial or continued employment, I agree to submit to such lawful examinations, medical, substance abuse or other, as may be required by the Company. The Company will pay the reasonable costs of any such examination that may be required.If I am hired, I agree that my employment and compensation can be terminated with or without cause and without notice, at any time, at the option of Korns Galvanizing Company, Inc. and myself.I have read and affirm as my own the above statement. If signing electronically, I am agreeing that the electronic signature is the legal equivalent of my manual signature on this page.
Signature:		Date:
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