W. B. Porter & Company, Inc.                   

Authorized Mettler Toledo Distributor                            

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Please provide the following information to be considered for employment at W. B. Porter & Co.  Fields marked with an * are required.

APPLICATION FOR EMPLOYMENT

 

PERSONAL INFORMATION

Date: 05/25/2005
Last Name* First Name* Middle

Present Address*
City*
State*   Zip* 
Home Phone*
Work Phone
Email Address

APPLICANT’S CERTIFICATION/CONSUMER DISCLOSURE

I understand that I am not required to answer any question I believe would deny me an equal employment opportunity. I certify that all the application information provided is true, correct, and complete to the best of my knowledge, and understand that false information may result in my dismissal, if hired.

In making this application for employment, I authorize W. B. Porter & Co.  to verify this information and release all parties from liability in providing information in verifying my application. It is understood that information verification which may be made through personal/telephone interviews and written requests may include but not be limited to work, education, criminal and/or credit, driving records/history, and professional credentials. These checks may be done by a third party investigative group.

I understand that any offer of employment is contingent upon successfully meeting the Company’s job related physical examination standards that include drug testing and successfully meeting full security and reference verifications. Also, I understand that while the Company makes every effort to provide steady employment, I am not guaranteed a permanent position, if hired, and acknowledge that I have and the Company has a right to discontinue our employment relationship at any time.

Applicant Name/Acknowledgment* 

Date*  (mm/dd/yy)

Position you are interested in
*

Salary Requirements* 


Have you ever been convicted of an unlawful offense other than minor traffic violations?*
Yes No If yes, description is required:

Have you ever been employed by W. B. Porter & Co.?* Yes No

If yes, when?

Are you willing to take a physical examination/drug screening at the expense of W. B. Porter & Co.?*
Yes No (If no, see Applicant’s Certification/Consumer Disclosure.)
Are you 18 or over?*
 Yes No

Do you have a valid driver’s license?* Yes No If yes, License #
License State

Do you have a valid CDL?* Yes No If yes, Class/ type


Are you currently employed?* Yes No
If yes, may we contact your current employer? Yes No
Who referred you?* 

EMPLOYMENT HISTORY

Date you will be available for employment?*

Military Service*

U.S. Military Service* Yes No
Rank Branch


Work History* or check here if none
List your former employer's information. Begin with your most recent employer.

*Required unless none is checked above.
Employer Name:
Address:
City: State: Zip:
Supervisor:
Beginning Position: Duties:



Ending Position: Duties:



Phone:

Dates Employed:
From:
To:
Salary:
Start:
End:
Reason for leaving:


 
Employer Name:
Address:
City: State: Zip:
Supervisor:
Beginning Position: Duties:



Ending Position: Duties:



Phone:

Dates Employed:
From:
To:
Salary:
Start:
End:
Reason for leaving:


 
Employer Name:
Address:
City: State: Zip:
Supervisor:
Beginning Position: Duties:



Ending Position: Duties:



Phone:

Dates Employed:
From:
To:
Salary:
Start:
End:
Reason for leaving:


 
Employer Name:
Address:
City: State: Zip:
Supervisor:
Beginning Position: Duties:


 
Ending Position: Duties:

 

Phone:

Dates Employed:
From:
To:
Salary:
Start:
End:
Reason for leaving:


EDUCATION *

Highest grade completed * 

High School College or
University		 Other
Name and address
of school attended
Did you graduate?* Yes No
Attending		 Yes No
Attending		 Yes No
Attending
Major course of study

OTHER SKILLS/EXPERIENCE

Computer Skills (List all computer experience including software, hardware, and level of expertise)



Special Skills and General Comments
(Optional – Elaborate on any special skills or general information applicable to the position applied for).  You may cut/paste a resume into this space.  NO ATTACHMENTS, PLEASE.