Application for Employment s105

Application for EmploymentOur policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.Date ______Last name ______First name ______Middle ______Street Address ______City ______State ______ZIP ______Telephone ______Social Security # ______Position applied for ______How did you hear of this opening? ______When can you start? ______Desired Wage $______Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.)  Yes  No Are you looking for full-time employment?  Yes  No If no, what hours are you available? ______Are you willing to work second shift?  Yes  No Are you willing to work third shift?  Yes  No 90 River St. New Haven, CT 06513 - Ph: 203-624-1345 - F: 203-786-5041 Have you ever been convicted of a felony? (This will not necessarily affect your application.)  Yes  No If yes, please describe conditions. ______________________________Date of Last Physical ____/____/_____Education School Name and Location Year Major DegreeHigh School ______College ______College ______Post-College ______Other Training ______In addition to your work history, are there other skills, qualifications, or experience that we should consider? ____________Employment History (Start with most recent employer)Company Name ______Address ______Telephone ______Date Started ______Starting Wage ______Starting Position ______Date Ended ______Ending Wage ______Ending Position ______Name of Supervisor ______May we contact?  Yes  No90 River St. New Haven, CT 06513 - Ph: 203-624-1345 - F: 203-786-5041 Responsibilities ______Reason for leaving ______Company Name ______Address ______Telephone ______Date Started ______Starting Wage ______Starting Position ______Date Ended ______Ending Wage ______Ending Position ______Name of Supervisor ______May we contact?  Yes  NoResponsibilities ____________Reason for leaving ______Employment Experience (check those that apply) Years Experienced in that category (Yrs Exp.) Licensed Fork Truck Operator Yrs Exp______ Class A Driver License Yrs Exp______ Class B Driver License Yrs Exp______ Electric Pallet Mover Yrs Exp______ Order Picker Yrs Exp______ OSHA 10 Yrs Exp______ OSHA 30 Yrs Exp______ NACE Certification Level______Yrs Exp______ Spray Painting Conventional or HVLP Guns Yrs Exp______ Spray Painting Airless Guns Yrs Exp______ Spray Painting Electrostatic Guns Yrs Exp______ Spray Painting Plural Component Guns Yrs Exp______90 River St. New Haven, CT 06513 - Ph: 203-624-1345 - F: 203-786-5041  Spray Painting Atomizer Yrs Exp______ Metalizing Yrs Exp______ Welding (certification______) Yrs Exp______ Powder Coating Manual Guns Yrs Exp______ Powder Coating Automatic Guns Yrs Exp______ Powder Coating Robotic (Type______) Yrs Exp______ Bondo and Filling Experience Yrs Exp______ Masking Yrs Exp______ PAD Printing Yrs Exp______ Screen Printing Yrs Exp______ Screen Printing Automatic Yrs Exp______ Art Work Development Yrs Exp______ Pad Printing Plate Making Yrs Exp______ Abrasive Blasting (not box blasting) Yrs Exp______ Grinding Yrs Exp______ Machine Sanding Detailing Yrs Exp______ Buffing and Finishing Yrs Exp______ Assembly Work Yrs Exp______ Packaging Yrs Exp______ Quality Inspection (fill in Quality Section) Yrs Exp______ 6’s Programs Yrs Exp______ MIL-DTL-5541 Chromate Pretreatments Yrs Exp______ Automated Conveyor System Painting Yrs Exp______ Automated Conveyor System Powder Coating Yrs Exp______Quality Experience (check those that apply) Years Experienced in that category (Yrs Exp.)90 River St. New Haven, CT 06513 - Ph: 203-624-1345 - F: 203-786-5041  DFT Mil Gauge ASTM D7091  Air Humidity, Dew Point and Temp measurements  ASTM D3359 Adhesion Testing  Visual Inspection of Coating  Salt Spray and Humidity Finishes Testing  PPAP  Gloss Level Reading ASTM D353 - 08  FMEA Profile (abrasive blasting)  Control Plan Development Testing ASTM D4417  SOP & WI development and  Water Break Testing ASTM F22 Writing -13  KIZAN Experience (Belt  6’s Programs Color_____)Painting Experience (check those that apply) Years Experienced in that category (Yrs Exp.) Epoxy Paints Coatings  Lacquer Coatings Zinc Inorganic Coatings  Water Borne Coatings Zinc Organic Coatings  Moisture Cure Coatings Urethane Coatings  Mil Spec Coatings CARC Polyester Coatings  Mil Spec Coatings Others EMI/RFI Shielding  Teflon Coatings Please write a short explanation on why you want to work for Niklyn Corp. Please include what you think you can bring to our company (positive attributes you may have), how you work within a team or on your own, as well as how you do with dead lines. Attach separate sheet if needed90 River St. New Haven, CT 06513 - Ph: 203-624-1345 - F: 203-786-5041  Optional: Please explain one or more Goals that you have that you think you can accomplish while working at Niklyn Corp. Attach separate sheet if needed I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history.  I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing. Signature______Date ______ Office use:90 River St. New Haven, CT 06513 - Ph: 203-624-1345 - F: 203-786-5041

Application for Employment s105

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