Online Employment Application

Name *

First

Last

Email *

Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Today's Date

Position(s) Applied For

Please select shift(s) you are applying for. *

First 7 am- 3:30 pm
Second 3:30 pm - 12 am
Third 11:30 pm- 8 am

Date You Are Available to Start Work

Were you previously employed by this organization?

Yes
No

If you answered "yes," please list the dates of your previous employment and what postition(s) you held.

Please list any relatives or friends working for this organization and your relationship to them.

WORK EXPERIENCE

PLEASE LIST PRESENT AND FORMER EMPLOYERS BEGINNING WITH MOST RECENT

Name of Most Recent Employer

Phone Number of Most Recent Employer

Address of Most Recent Employer

Address Line 1

Address Line 2

City

State

Zip Code

Start Date

End Date

Last Position Held

Supervisor's Name and Title

Describe your work.

Reason for Leaving

May we contact them?

Yes
No

Name of Previous Employer

Phone Number of Previous Employer

Address of Previous Employer

Address Line 1

Address Line 2

City

State

Zip Code

Start Date

End Date

Last Position Held

Supervisor's Name and Title

Describe your work.

Reason for Leaving

May we contact them?

Yes
No

Name of Previous Employer

Phone Number of Previous Employer

Address of Previous Employer

Address Line 1

Address Line 2

City

State

Zip Code

Start Date

End Date

Last Position Held

Supervisor's Name and Title

Describe your work.

Reason for Leaving

May we contact them?

Yes
No

Can you read English?

Yes
No

Can you write English?

Yes
No

Have you served an apprenticeship?

Yes
No

If yes, please list in what trade, where you served, and dates of service.

Do you have your own transportation?

Yes
No

Special Skills and Qualifications - mechanical and/or technical experience and abilities relevant to the Position for which you have applied.

EDUCATION

Name of High School

High School Address

Address Line 1

Address Line 2

City

State

Zip Code

Did you graduate (or get a G.E.D.)?

Yes
No

How many years did you attend high school?

Name of College (if you attended)

What was your major/course of study?

College Address

Address Line 1

Address Line 2

City

State

Zip Code

How many years did you attend college?

Name of Trade School or other program (if you attended)

What was your major/course of study?

Trade School (or other) Address

Address Line 1

Address Line 2

City

State

Zip Code

How many years did you attend?

REFERENCES

First Reference Name

First

Last

First Reference Phone Number

First Reference Address

Address Line 1

Address Line 2

City

State

Zip Code

What is your relationship to this reference and how long have you known them?

Second Reference Name

First

Last

Second Reference Phone Number

Second Reference Address

Address Line 1

Address Line 2

City

State

Zip Code

What is your relationship to this reference and how long have you known them?

Third Reference Name

First

Last

Third Reference Phone Number

Third Reference Address

Address Line 1

Address Line 2

City

State

Zip Code

What is your relationship to this reference and how long have you known them?

MISCELLANEOUS INFORMATION

Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court? (A conviction record will not necessarily be bar to employment.)

Yes
No

If "yes" please explain and describe in full detail.

After employment, can you submit a birth certificate or other proof of U.S. citizenship or other proof of the right to remain in or work in the U.S.?

Yes
No

If you have a resume, please upload here.

Click or drag a file to this area to upload.

APPLICANT'S CERTIFICATION --Please read carefully before submitting.

I certify that the answers given by me to the foregoing questions and the statements made by me in this application are correct and complete. I understand that, if I become employed, a misrepresentation or omission of fact in this application may result in my discharge from employment. I authorize Hudson Valley Plastics (the Company), as part of its evaluation of my suitability for employment, to contact all school officials, references, and my previous supervisors to secure information regarding my skills, character and ability. I further acknowledge and agree that no manager or representative of the Company has any authority to enter into any employment agreement. I understand and agree that, if I am employed, I will be an at-will employee and the Company may terminate my employment at any time and for any or no reason without prior notices.

WORK EXPERIENCE

EDUCATION

REFERENCES

MISCELLANEOUS INFORMATION

APPLICANT'S CERTIFICATION --Please read carefully before submitting.

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