SHUPPER-BRICKLE EQUIPMENT CO - ACCO Material Handling Solutions

About You

Last Name*

First Name*

Middle Name*

Email*

Address*

City*

State*

Zip*

Phone Number*

Person to notify in case of accident or emergency:

Name*

Phone Number*

Address*

Position Applied for*

Salary Desired*

How Were You Referred To ACCO?*

Have you ever been convicted of a crime?*
YesNo

If yes, when, where, and nature of offense?

Are you 18 years of age or older?*
YesNo

Are you legally eligible for employment in the United States?*
YesNo

Are you a veteran of the United States Military Service?*
YesNo

Branch of Service

From

To

Rank and Type of Service

Training/Experience Received

Do you wish to be identified as a handicapped individual and to be considered under our Handicapped Affirmative Action Program?*
YesNo

Have you worked for ACCO before?*
YesNo

If yes give dates:

From

To

Division/Department

Is any additional information relative to change of name, use of an assumed name, or nickname necessary to check your work or educational record?
YesNo

If Yes, give the name(s)

Education

Name/Location of High School*

Course of Study*

Years Completed*

Did you graduate*

Diploma or Degree*

Name/Location of College

Course of Study

Years Completed

Did you graduate

Diploma or Degree

Name/Location of additional College

Course of Study

Years Completed

Did you graduate

Diploma or Degree

Name/Location of Other School

Course of Study

Years Completed

Did you graduate

Diploma or Degree

Employment Experience (Most recent first)

Employer 1

Employer*

Employer Address*

Employer Phone*

Start Date*

End Date*

Job Title*

Salary Start*

Salary End*

Supervisor Name*

Reason for Leaving*

Employer 2

Employer

Employer Address

Employer Phone

Start Date

End Date

Job Title

Salary Start

Salary End

Supervisor Name

Reason for Leaving

Employer 3

Employer

Employer Address

Employer Phone

Start Date

End Date

Job Title

Salary Start

Salary End

Supervisor Name

Reason for Leaving

Employer 4

Employer

Employer Address

Employer Phone

Start Date

End Date

Job Title

Salary Start

Salary End

Supervisor Name

Reason for Leaving

May we contact present and prior employers?*
YesNo

If No, Indicate those you do not wish contacted

Special training or skills*

Hobbies and Interests*

Attach Resume

APPLICANT’S STATEMENT

I understand that the employer follows an “employment at will” policy, in that I or the employer may terminate my employment at any time, or for any reason consistent with applicable state or federal law; this “employment at will” policy cannot be changed verbally or in writing, unless the change is specifically authorized in writing by the chief operating office of this organization. I understand that this application is not a contract of employment. I understand that federal law prohibits the employment of unauthorized aliens; all persons hired must submit satisfactory proof of employment authorization and identity; failure to submit such proof will result in denial of employment.

I understand this application will be active for a period of one year, after that time, if I wish to be considered for employment, I must submit a new application.

I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein, except my current employer if so noted, to provide any information requested about me, and I release them from all liability for damage in providing this information.

I certify that all the statements herein are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal of employment.

I agree.

eSignature - Your Full Name*

Please leave this field empty.

Date*

INNOVATE. COLLABORATE. EXPAND.

Employer 1

Employer 2

Employer 3

Employer 4