Employment Form Manufacturing Engineer

Middle Name

Last Name(required)

First Name(required)

Address(required)

City(required)

State(required)

Zip(required)

Home Phone(required)

Cell Phone

Email address(required)

Position Applying For(required)

Salary Desired(required)

Have you ever been employed with us before?(required)

Yes

If yes, Who was your supervisor?

Are you legally eligible to work in the U.S.?(required)

Yes

Do you now or will you in the future require visa sponsorship for employment at Kirkhill?(required)

Yes

Can you work nights?(required)

Yes

When could you start?(required)

If hired, are you willing to submit to and pass a controlled substance test?(required)

Yes

If no state reason.

Education

High School

Name of School

Type of School

No. of Years Completed

Major & Degree Obtained

College

Name of School

Type of School

No. of Years Completed

Major & Degree Obtained

Business or Trade School

Name of School

Type of School

No. of Years Completed

Major & Degree Obtained

Professional School

Name of School

Type of School

No. of Years Completed

Major & Degree Obtained

Typical Physical Demand Requirements Include: Full range of body motion, normal range of vision, frequent bending and stooping, standing for long periods of time, lift up to 75 pounds on a regular basis.

Typical General Duty Requirements: Read a tape measurer, basic arithmetic, reading and writing, computer work, following directions from supervisor, learn job an

Are you able to perform the essential functions listed above for the job in which you are applying, either with or without reasonable accommodation?(required)

Yes

If NO, describe the functions that cannot be performed.

Please describe any additional information that may be helpful to us in considering your application.

Work Experience

Please list your 3 most recent jobs, beginning with the most recent job held.

1

Company

Job Title

Address

City

State

Zip

Phone

Employed From

Employed To

Still Employed?

Yes

Reason For Leaving

2

Company

Job Title

Address

City

State

Zip

Phone

Employed From

Employed To

Still Employed?

Yes

Reason for Leaving

3

Company

Job Title

Address

City

State

Zip

Phone

Employed From

Employed To

Still Employed?

Yes

Reason for Leaving

Attach A Resume

Maximum size 10MB

I understand the employment relationship is “at will” and may be terminated for any or no reason without prior notice by either party. I further understand this written statement supersedes any and all oral representations made by agents or representatives of this company. I certify that the information on this application, on related papers, and in interviews is true, correct and complete. I recognize that false, misleading or omitted information will result in discharge or refusal of employment. I authorize the employer to make inquiries concerning prior work experience. I release from liability all persons, companies and corporations supplying any such information. I have read and understand the above statements.

Signature(required)

Date

It is the policy of Kirkhill Inc. to recruit, hire, train, and promote employees without discriminating based on race, sex, sexual orientation, gender identity, age, religion, national origin, veteran status or disability. Kirkhill recognizes that the effective application of such a policy of merit employment involves more than just a statement. We therefore train and advise those who are in a position to make decisions that regard hiring, salary administration and other terms and conditions of employment in the positive application of this policy. In addition, this policy will be made known to all employees of Kirkhill and all recruitment sources, such as employment agencies, newspapers, and all persons who come to Kirkhill for the purpose of seeking employment. If you are a qualified individual with a disability or a disabled veteran, you have a right to request a reasonable accommodation for purposes of participating in the application/hiring process. If you are unable or limited in your ability to use or access our web site as a result of your disability, you can request reasonable accommodations by calling our offices.

Voluntary EEO Survey

Yes

Voluntary EEO Survey

Government agencies require periodic reports on the sex and ethnicity of applicants and employees. This data will be used for analysis and reporting only. Submission of information is voluntary.

Gender

Male

Female

Definitions

Hispanic or Latino:A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not of Hispanic origin): All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
Black (Not of Hispanic origin): All persons having origins in any of the Black racial groups of Africa.
Asian: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent
Native Hawaiian or Pacific Islander: All persons having origins in Hawaii, Guam, Samoa, or other Pacific Islands.
American Indian or Alaskan Native: All persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.
Two or More Races: All persons who identify with more than one of the above races.

Voluntary Background Investigation Approval Form

Yes

Background Investigation Approval Form

CALIFORNIA DISCLOSURE DOCUMENT

Kirkhill Inc. (the “Company”) may order an “investigative consumer report” (a background check report) on you in connection with your employment or application for employment (including independent contractor or volunteer assignments, as applicable). The investigative consumer report may contain information about your character, general reputation, personal characteristics, and mode of living. As allowed by law, such reports may contain the following information pertaining to you: credit history; public records; a Social Security number verification; driving records; military service; credentials/certifications; and verification of prior employment and education. The Company may not order an investigative consumer report about you without your written authorization (which you may provide through a separate document called the Authorization for Background Checks).

The agency conducting the investigation and preparing the background report for the Company is ADP Screening and Selection Services, Inc. (ADP SASS), at 301 Remington Street, Fort Collins, CO, 80524; phone number 800-367-5933; website, http://www.adpselect.com. This website contains information concerning ADP SASS’ privacy practices.

A Summary of Your Rights Under the Provisions of California Civil Code Section 1786.22

(a) An investigative consumer reporting agency shall supply files and information required under Section 1786.10 during normal business hours and on reasonable notice.

(b) Files maintained on a consumer shall be made available for the consumer's visual inspection, as follows:

(1) In person, if he appears in person and furnishes proper identification. A copy of his file shall also be available to the consumer for a fee not to exceed the actual costs of duplication services provided.

(2) By certified mail, if he makes a written request, with proper identification, for copies to be sent to a specified addressee. Investigative consumer reporting agencies complying with requests for certified mailings under this section shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the investigative consumer reporting agencies.

(3) A summary of all information contained in files on a consumer and required to be provided by Section 1786.10 shall be provided by telephone, if the consumer has made a written request, with proper identification for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to the consumer.

(c) The term "proper identification" as used in subdivision (b) shall mean that information generally deemed sufficient to identify a person. Such information includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if the consumer is unable to reasonably identify himself with the information described above, may an investigative consumer reporting agency require additional information concerning the consumer's employment and personal or family history in order to verify his identity.

(d) The investigative consumer reporting agency shall provide trained personnel to explain to the consumer any information furnished him pursuant to Section 1786.10.

(e) The investigative consumer reporting agency shall provide a written explanation of any coded information contained in files maintained on a consumer. This written explanation shall be distributed whenever a file is provided to a consumer for visual inspection as required under Section 1786.22.

(f) The consumer shall be permitted to be accompanied by one other person of his choosing, who shall furnish reasonable identification. An investigative consumer reporting agency may require the consumer to furnish a written statement granting permission to the consumer reporting agency to discuss the consumer's file in such person's presence.

Minnesota and Oklahoma applicants or employees only:

Yes

Please check this box if you would like to receive a copy of a consumer report if one is obtained by the company

California applicants or employees only:

Yes

You also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law.

Maiden Name

Date Changed

Other Names Used

Name

Date Changed

Name

Date Changed

List all cities and states where you have lived for the past 7 years

Current - Street City County State ZIP How long?

Street City County State ZIP How long?

Social Security Number

Driver’s License Number / State

This information will be used for background screening purposes only and will not be used as hiring criteria.

Sex

Male

Female

Date of Birth

Voluntary Self-Identification of Disability Form

Yes

Voluntary Self-Identification of Disability

Why are you being asked to complete this form?
We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years. Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

How do you know if you have a disability?
A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to:

•Alcohol or other substance use disorder (not currently using drugs illegally) •Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS •Blind or low vision •Cancer (past or present) •Cardiovascular or heart disease •Celiac disease •Cerebral palsy •Deaf or serious difficulty hearing •Diabetes •Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders •Epilepsy or other seizure disorder •Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome •Intellectual or developmental disability •Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD •Missing limbs or partially missing limbs •Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports •Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS) •Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities •Partial or complete paralysis (any cause) •Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema •Short stature (dwarfism) •Traumatic brain injury

Please check one of the boxes below:

Yes, I have a disability, or have had one in the past

No, I do not have a disability and have not had one in the past

I do not want to answer

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

Please review your answers before you submit your application form

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