Job Application Name* First Last Present Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Previous Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhonePosition or type of employment desiredAvailable For Full Time Part Time Temporary Date Available MM slash DD slash YYYY Rate of pay expectedWhy would you like to work in plastics manufacturing?Why are you interested in working for Quadel?Please describe what type of work you like bestCan you perform the essential functions of the job for which you are applying, with or without reasonable accommodation?YesNoIf necessary, can you work evenings, nights, and/or weekends?YesNoDo you have a valid drivers license?YesNoLicense #Do you have a Commercial Driver’s License?YesNoIf yes, please indicate the nature of offense, date, court & disposition. (A conviction will not necessarily disqualify an applicant from employment)EDUCATIONHigh SchoolSchool Name & AddressMajor SubjectGraduate?YesNoGive DegreeCollegeSchool Name & AddressMajor SubjectGraduate?YesNoGive DegreeBusiness, Trade, OtherSchool Name & AddressDates Attended From/ToMajor SubjectGraduate?YesNoGive DegreeDo you plan to further your education?YesNoIf yes, please explainSKILLSSelect your skills Select All Mechanical Power Tools Change Tires Change Oil Pull Motor Rebuild Motor EMPLOYMENT HISTORY List previous employers starting with most recent(1) Company Name & AddressEmployed 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startlastName & Title of Immediate SupervisorMain DutiesReason for leavingPhone(2) Company Name & AddressEmployed 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startlastName & Title of Immediate SupervisorMain DutiesReason for leavingPhone(3) Company Name & AddressEmployed 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startlastName & Title of Immediate SupervisorMain DutiesReason for leavingPhoneList periods of unemployment for more than 30 daysDate 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NOTE Applicant agrees to the following conditions of employment: If hired, I will receive a copy of the Quadel Employee Handbook and agree to fully and completely read it. I understand that neither this handbook nor any other communication by a management representative is intended to, in any way, create a contract of permanent employment or employment for a specified time. I further understand that my employment can be terminated at any time, with or without cause, and with or without notice, at the option of either the company or myself. I swear all statements in this application are true and correct. If any information is false, it will be cause for termination. I understand employment is contingent upon verification of identity to work in the United States. I certify that the information given by me to Quadel is true and complete to the best of my knowledge. I further certify that I am not engaged in any outside activity or business that could be considered in conflict with Quadel’s interest or those of its customers, nor will I become engaged in such activity or business if employed. If employed, I further agree that if during the course of my employment Quadel advances any paid leave to me before it has been earned or accrued, overpays me, or advances or loans me any money, or if through my dishonest or willful act, I lose, damage or fail to return any of Quadel’s property, my signature on this application is my authorization to Quadel to deduct from my wages or any other amounts Quadel may owe me, sufficient funds to repay what I owe Quadel or to replace Quadel’s property. If a conditional job is offered to me, I will be required to submit to a drug and alcohol test within 24 hours after being notified. Quadel actively and proudly promotes a safe, Drug and Alcohol free workplace. As a condition of employment all employees are subject to random drug and alcohol testing, post accident drug and alcohol testing and reasonable suspicion drug and alcohol testing. I hereby authorize Quadel to solicit information regarding my credit history and previous employment. I release all parties and persons connected with such solicitation from all claims, liabilities, and damages for any reason arising out of the furnishing of such information. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.