Application Certification and Agreement Please read carefully! CERTIFICATION OF TRUTHFULNESS. I certify that all statements on the Application for Employment are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed or if employed may result in my dismissal. AUTHORIZATION FOR EMPLOYMENT/EDUCATIONAL INFORMATION. I authorize the references listed in the Application for Employment, and any prior employer, educational institution or any other persons or organizations to give this Company any and all information concerning my previous employment/educational accomplishments, disciplinary information or any other pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I hereby waive written notice that employment information is being provided by any person or organization. EMPLOYMENT AT WILL. If I am hired, in consideration of my employment, I agree to abide by the rules and policies of Bunting Bearings, LLC including any changes made from time to time, and agree that my employment and compensation can be terminated with or without cause, with or without notice, at any time, at the option of either Bunting Bearings, LLC or myself. I understand that no officer, manager or supervisor of Bunting Bearings, LLC other that the President, has any authority to enter into any agreement for employment for any specific or indefinite period of time or to make any agreement contrary to the foregoing. Any such agreement made by the President must be made in writing to be effective. NEED FOR ACCOMMODATION. If I am a person with a disability who requires accommodation to perform the job, I must notify Bunting Bearings, LLC of this need. CRIMINAL RECORDS CHECK. I authorize Bunting Bearings, LLC to secure a criminal conviction history from the appropriate law enforcement agencies, should the Company determine it is necessary to do so. PHYSICAL EXAM AND RELEASE OF MEDICAL INFORMATION. I agree to take a physical exam following a job offer conditioned on passing a physical exam. I authorize every medical doctor, physician or other healthcare provider to provide any and all information, including but not limited to all medical reports, laboratory reports, X-rays or clinical abstracts relating to my previous health history or employment in connection with any examination, consultation, test or evaluation. I hereby release every medical doctor, healthcare personnel and every other person, firm, officer, corporation, association, organization or institution which shall comply with the authorization or request made in this respect from any and all liability. I understand that this release will not be sent to my physician or other healthcare provider until a job offer has been made. DRUG AND ALCOHOL TESTING. I agree to provide Bunting Bearings, LLC with appropriate specimens to determine or exclude the presence of alcohol, drugs and other substances. I understand that decisions concerning my employment will be made as a result of this test. CONSIDERATION FOR EMPLOYMENT. I understand that my application will be considered pursuant to the Company’s normal procedures for a period of sixty (60) days. If I am still interested in employment thereafter, I must reapply. AUTHORIZATION TO WORK. If I am selected for hire I will be offered employment provided I verify that I am authorized to work as required by the Immigration Reform and Control Act of 1986. LIMITATION ON CLAIMS. I agree that any action or suit against the Company arising out of my employment or termination of employment, including but not limited to claims arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claim or be forever barred. I waive any statute of limitation to the contrary. I have read and understand items 1 through 10 above and acknowledge that with my signature below.SignatureDate DD slash MM slash YYYY *It is the policy of this Company not to discriminate in its employment and personnel practices because of a person’s genetic information, race, color, religion, sex, age, national origin, disability, ancestry, veteran status, sexual orientation or any other status protected by applicable law. Application for Employment (PRE-EMPLOYMENT QUESTIONNAIRE) (AN EQUAL OPPORTUNITY EMPLOYER) General InformationLocation* Holland, Ohio Portage, Michigan Delta, Ohio Mansfield, Ohio Houston, Texas Date* MM slash DD slash YYYY Last Name*First Name*Middle Name*Present AddressAddress*City*State*Select stateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip*Telephone*Email Address* Do you have a legal right to work in the U.S. either as a U.S. citizen or authorized alien?* Yes No Are you age 18 or older? Yes No Is there any additional information relative to a different name necessary to check your work and/or education record? Yes No If yes, explainOther InformationPosition applied for Full Time Part Time Third Temp Can you perform the essential functions of the job(s) for which you are applying, with or without reasonable accommodation? Yes No If no,why?Shift Preference (Check all that apply) 1st 2nd 3rd Rate of Pay Expected $perHave you ever worked for this Company?If so,When?List everyone you know who works for Bunting Bearings, LLCHow did you hear about us? Walk-In Advertisement Friend/Relative Other When are you available to start work?Have you ever been convicted of any crime other than a routine traffic offense? Yes No If yes, describe each (include all convictions, any plea of "no contest" or "guilty" unless expunged)Are you presently on parole or probation? Yes No Are you currently under indictment, arraignment or other criminal charge? Yes No If yes, describeEducationName of InstitutionCity and State of SchoolDid you graduate? Yes No Number of years attended?Degree Received Yes No Type of DegreeThis field is hidden when viewing the formSection BreakClick to add another Education (Click to add another Education) Name of InstitutionCity and State of SchoolDid you graduate? Yes No Number of years attended?Degree Received Yes No Type of DegreeThis field is hidden when viewing the formSection BreakClick to Education (Click to add another Education) Name of InstitutionCity and State of SchoolDid you graduate? Yes No Number of years attended?Degree Received Yes No Type of DegreeWork History List Most Recent Job FirstName of EmployerAddressCityStateSelect stateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip CodePhone numberEmployment DatesTo (Mo/Yr)Name of Last SupervisorYour Last Job TitleReason for leaving (Be Specific)Please upload any related files:Max. file size: 256 MB.This field is hidden when viewing the formSection BreakWork Click to add another Employer (Click to add another Employer) Name of EmployerAddressCityStateSelect stateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip CodePhone numberEmployment Dates MM slash DD slash YYYY MM slash DD slash YYYY Name of Last SupervisorYour Last Job TitleReason for leaving (Be Specific)Please upload any related files:Max. file size: 256 MB.This field is hidden when viewing the formSection BreakWork two Click to add another Employer) (Click to add another Employer) Name of EmployerAddressCityStateSelect stateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip CodePhone numberEmployment Dates MM slash DD slash YYYY MM slash DD slash YYYY Name of Last SupervisorYour Last Job TitleReason for leaving (Be Specific)Please upload any related files:Max. file size: 256 MB.U.S. Armed Forces Service? Yes No FromToBranch of ServiceDutiesRank or rating at time of enlistment and dischargeMilitary discharge statusResumePlease attach your resume:Max. file size: 256 MB.List any professional and association memberships and licenses or certifications you may have. (NOTE: You need not list those which indicate race, color, religion, sex, national origin, age, disability orany other protected classification.)List any other skills or qualifications you feel would be helpful for consideration of employment. (Include any machines or equipment you can set up and operate.)Indicate any employers you do not wish us to contact and whyCaptcha Δ
