TRAFFIC CONTROL DEVICES, INC.

AN EQUAL OPPORTUNITY EMPLOYER

APPLICATION FOR EMPLOYMENT

**PLEASE PRINT**

 

Position(s) Applied For:______________________________________________

Date of Application____/____/____

Referral Source:                                 ___Advertisement      ___Employee      ___Walk-in

                                                      ___Relative               ___Employment Agency

                                                      ___Other                  Name Source_____________________

 ____________________________________________________________________________________


Name:_______________________________________________________________________________
                    Last                                           First                                      Middle

Address:_____________________________________________________________________________
                   Street                                          City                    State          Zip Code

Where may we contact you? Home #(____)_______________ 
                                                Area Code

Social Security Number_____-_____-_____
                                                

Have you applied here before?____Yes  ____No           If so, what date?_____/_____/_____

If you have been employed here before, when?    From_____/_____/_____ To_____/_____/_____

Are you legally eligible for employment in this country?____Yes   ____No
Proof of U.S. Citizenship or immigration status will be required upon employment.

Type of employment desired   ____Full   ____Part   ____Temp   ____Educational Co-Op

Date available for work____/____/____       Will you work overtime?   ____Yes   ____No

Will you relocate if job requires it?   ____Yes   ____No    Will you travel?  ____Yes   ____No

Are you able to meet the attendance requirements of the position?    ____Yes   ____No

Have you ever been bonded?    ____Yes   ____No

Have you ever been convicted of a felony in the past seven years?  ____Yes   ____No
Such conviction may be relevant if job related, but does not restrict you from employment.

If Yes, Please explain:______________________________________________________________

  _______________________________________________________________________________

Driver's License Number:______________________________________________  State:_______

Date of Birth:_______________________________
REFERENCES

List three business/work references who are not related to you and are not previous supervisors. If not
applicable, list three personal references.

  Name                                                Telephone                                              Years Known

____________________________________(____)_____-______________________________________

____________________________________(____)_____-______________________________________

____________________________________(____)_____-______________________________________
EDUCATIONAL BACKGROUND
A. List the last three (3) schools (most recent first).

B. List number of years completed.

C. Indicate degree or diploma earned, if any

D. Major field of study.

E. Minor field of study (if applicable).
A. School                B. Years Completed            C. Degree             D. Major                E. Minor

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

List any foreign language(s) and check the box that best describes your level.

Language        Read and Write              Read and Speak               Read Only            Speak Only

___________________________________________________________________________________

___________________________________________________________________________________

List any additional information you would like us to consider.

___________________________________________________________________________________

___________________________________________________________________________________

It is understood and agreed upon that any misrepresentation by me in this application will be 
sufficient cause for cancellation of this application and/or separation from the employer's 
service if I have been employed. Furthermore, I understand that just as I am free to resign
at any time, the Employer reserves the right to terminate my employment at any time, with 
or without cause and without prior notice. 
I understand that no representative of the Employer has the authority to make any assurances 
to the contrary.

I give the Employer the right to investigate all references and to secure additional information 
about me, if job related. I hereby release from liability the Employer and its representatives 
for seeking such information and all other persons, corporations or organizations for 
furnishing such information.

The Employer is an Equal Opportunity Employer. The Employer does not discriminate in 
employment and no question on this application is used for the purpose of limiting or 
excusing any applicant's consideration for employment on a basis prohibited by local, 
state or federal law.

This application is current for only 90 days. At the conclusion of this time, if I have not 
heard from the Employer and still wish to be considered for employment, it will be necessary 
to fill out a new application.

I recognize and accept as a term of hire a 90-day Probationary Period with TRAFFIC 
CONTROL DEVICES, INC.  I further understand that if my job performance is unacceptable, 
I may be terminated at any time during that period.

Signature of Applicant_______________________________________ Date____/____/____

EMPLOYMENT HISTORY
List your last three (3) employers or assignments, starting with the most recent, including Military experience.
Employer               Telephone                       Dates Employed          Summarize work performed 
                           (   )                               From        to                 and job responsibilities
 _________________________________________________________________________________
Address
 _________________________________________________________________________________
Job Title                                                                            Hourly Rate/Salary Starting
                                                                                                     
______________________________________________________  $_________Per_______ 
Immediate Supervisor and Title

___________________________________________________________________________ 

Reason for Leaving                                                               Hourly Rate/Salary Final

_______________________________________________________ $_________Per_______

May we contact for reference?     ___Yes  ___No  ___Later


Employer               Telephone                       Dates Employed         Summarize work performed 
                           (   )                               From        to               and job responsibilities
 __________________________________________________________________________________
Address
 __________________________________________________________________________________
Job Title                                                                              Hourly Rate/Salary Starting

________________________________________________________$_________Per_______ 
Immediate Supervisor and Title

____________________________________________________________________________

Reason for Leaving                                                                 Hourly Rate/Salary Final

________________________________________________________ $_________Per_______

May we contact for reference?     ___Yes  ___No  ___Later



Employer               Telephone                       Dates Employed        Summarize work performed  
                           (   )                               From        to               and job responsibilities
 ___________________________________________________________________________________
Address
 ___________________________________________________________________________________
Job Title                                                                                 Hourly Rate/Salary Starting

_________________________________________________________ $_________Per________
Immediate Supervisor and Title

______________________________________________________________________________ 

Reason for Leaving                                                                    Hourly Rate/Salary Final

__________________________________________________________$_________Per_______

May we contact for reference?     ___Yes  ___No  ___Later       

 

SKILLS AND QUALIFICATIONS
Summarize special skills and qualifications you may have acquired from previous employment or 
other experiences that my qualify you to work with our company.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________