Application for Employment


NOTICE TO ALL APPLICANTS: AO Precision is a drug free workplace. All applicants being considered for employment will be required to undergo a drug screen. Refusal to submit or positive results of this test will prohibit you from being offered employment or are grounds for rescinding offer if one has been made.


All Fields Marked With An Asterisk * Are Required.


It is the policy of Galion LLC to ensure equal opportunity in employment, recruitment, training, promotion, transfer, demotion, layoff, termination, compensation and benefits derived from any of the company’s facilities, privileges, or services. These policies will be administered without regard race, color, religion, gender, national origin, disability status, genetic information and testing, Family & Medical Leave, sexual orientation and gender identity or expression, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.

For equal employment opportunity statistical data, the human resources department requests that you volunteer the information requested. Your participation is not a condition of employment.

This section is not to be considered a part of the application for employment. This section is filed apart from the employment application. All information will be considered strictly private and confidential and will be used for EEO purposes only.

Sex:  Male Female
With which ethnic group do you belong:
Are you a veteran of the Vietnam era? Yes No    Date of discharge:

PERSONAL INFORMATION

Last Name:*
First Name:*
MI:
Address:*
City:*
State:*
Zip:*
Phone Number:*
xxx-xxx-xxxx
Email:*
If you are under 18 years of age, do you have a work permit?
 Yes No

YOUR JOB INTERESTS

Please Select Desired Position:*
Date you can start work:*
What starting salary or wage do you expect:*
Which shift(s) are you available to work?*
 1st 2nd 3rd All
Are you available to work overtime?*
 Yes No
How did you learn about this position?* (Newspaper, Internet, Friend, If other-please list)
Have you ever worked for this company before?*
 Yes No
When?
Why did you leave?
Do you know anyone who works here?*
 Yes No
Who?

YOUR EDUCATION AND TRAINING

Please Select Highest Grade Completed:*
Did you graduate?*
 Yes No
What degree(s) have you achieved?*

YOUR WORK EXPERIENCE

Beginning with your present or most recent employer, describe your employment experiences below:
Are you presently employed?*
 Yes No
 
1. Present or Last Employer:
Address:
Kind of Business:
Phone:
xxx-xxx-xxxx
Starting Position:
Pay: $
Final Position:
Pay: $
Dates Employed:
From: To:
Name and Title of Supervisor
Description of Your Work and Responsibilities:
Reason for Leaving:
May we contact this employer?
 Yes No
If No Why?
 
2. Next Previous Employer:
Address:
Kind of Business:
Phone:
xxx-xxx-xxxx
Starting Position:
Pay: $
Final Position:
Pay: $
Dates Employed:
From: To:
Name and Title of Supervisor
Description of Your Work and Responsibilities:
Reason for Leaving:
May we contact this employer?
 Yes No
If No Why?
 
3. Next Previous Employer:
Address:
Kind of Business:
Phone:
xxx-xxx-xxxx
Starting Position:
Pay: $
Final Position:
Pay: $
Dates Employed:
From: To:
Name and Title of Supervisor
Description of Your Work and Responsibilities:
Reason for Leaving:
May we contact this employer?
 Yes No
If No Why?
 
4. Next Previous Employer:
Address:
Kind of Business:
Phone:
xxx-xxx-xxxx
Starting Position:
Pay: $
Final Position:
Pay: $
Dates Employed:
From: To:
Name and Title of Supervisor
Description of Your Work and Responsibilities:
Reason for Leaving:
May we contact this employer?
 Yes No
If No Why?

PERSONAL INFORMATION

If you are hired, can you submit verification of your legal right to work in the United States?*
 Yes No
Have you ever been discharged or asked to resign by an employer?*
 Yes No
If yes, please explain:
Have you ever been convicted of or plead guilty to a crime, other than minor traffic violations?*
 Yes No
If your answer is yes, please explain:

YOUR MILITARY EXPERIENCE

Completing this section of the application is optional. Leave this area blank if you do not wish to answer.
Have you ever been in the United States Armed Services?
 Yes No
Dates of Duty:
From: To:
Describe any skills you acquired in the Service that would be useful to the job for which you are applying:

YOUR REFERENCES

List the names of any professional references who have known you for at least three years. Please do not list relatives or employers.
 
Reference 1
Name:*
Occupation:*
Address:* City:*
Phone:*
xxx-xxx-xxxx
 
Reference 2
Name:*
Occupation:*
Address:* City:*
Phone:*
xxx-xxx-xxxx
 
Reference 3
Name:*
Occupation:*
Address:* City:*
Phone:*
xxx-xxx-xxxx


Please Read The Following Paragraphs Carefully Before Signing And Initialing After Each Paragraph

By signing below and initialing after each paragraph, I certify that I have read, understand and agree to each of the following statements:

All of the information I have supplied on this application is true, accurate and complete, to the best of my knowledge, and I have not knowingly withheld any information that, if known to Galion LLC, would affect my application unfavorably.  If I am hired by Galion LLC, and if Galion LLC discovers at any time during my employment that any of the statements or answers on this application are false, misleading or incomplete, I may be dismissed immediately from my job. 
Initial Here:*

This employment application will be considered active for one (1) year from the date below.  If I want to be considered for a job with Galion LLC after this period of time I must fill out another application.  If hired, I understand that this application becomes part of my official employment record.  In consideration of my employment with Galion LLC, I agree to abide by all Galion LLC's rules and regulations.
Initial Here:*

If I am extended an offer of employment, I agree to submit to a medical examination that  will include testing for drugs or alcohol prior to beginning work with Galion LLC and I understand that any offer of employment is conditioned upon passing such medical examination and/or testing.  I understand that if I am employed by Galion LLC, I may be required, when job related and consistent with Galion LLC's business needs, to undergo a medical examination.  I further understand that I may be required to submit to a test for the use alcohol and/or of illegal drugs at any time.
Initial Here:*

I understand that nothing in this employment application creates a contract of employment between Galion LLC and me.  If I am hired by Galion LLC, my employment and compensation are "at will," which means that my employment can be terminated, either by Galion LLC or me, with or without cause, and with or without notice.  I understand that no manager or supervisor has the authority to make any employment agreement with me, either orally or in writing, that is not an at-will agreement.  Only the President of Galion LLC has the authority to enter into an employment agreement with me for any specified period of time.
Initial Here:*

I agree to release to Galion LLC or its designated agents, all medical information, including but not limited to files, reports, x-rays, evaluations and opinions held by medical personnel, to the extent such information is job-related and consistent with Galion LLC's business needs, and agree to execute the necessary HIPAA-compliant release.  I acknowledge that this is a general release and that if hired, it remains in effect for the duration of my employment.
Initial Here:*

In the event of my personal indebtedness to Galion LLC, I authorize Galion LLC to withhold from my wages such amounts as permitted by law to satisfy my obligation to Galion LLC.  
Initial Here:*

I give Galion LLC my permission to conduct any investigation regarding the information contained in my employment application that Galion LLC thinks is necessary to determine my qualifications for assuming a job with Galion LLC.  I give Galion LLC my permission to contact any former employer, school, college or university, utility company, credit or finance bureau or office, any personal or professional reference, or any other appropriate source or individual for the purpose of gathering any information, personal or otherwise, that such sources may have about my character, general reputation, credit, education or employment record, and I give my consent to any such source to release to Galion LLC whatever information they have about me.  I also unconditionally release all named and unnamed sources from any and all liability which might result from furnishing any information about me. 
Initial Here:*

In exchange for Galion LLC considering my application, I agree that any claim or lawsuit I have now or in the future against Galion LLC its subsidiaries, successors, assigns, managers, employees and/or agents must be filed by me within one year from the date of the act or omission that is the subject of my claim or lawsuit, or within the applicable statute of limitations, whichever time period is shorter.  Thus, I expressly waive any statute of limitations period for any such claim or lawsuit longer than one year, regardless of the nature of the claim or action.  As further consideration for these promises by me, Galion LLC agrees to waive any statute of limitations period longer than one year from the date of the act or omission that is the subject of any claim or lawsuit it might file against me.
Initial Here:*

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APPLICANT SIGNATURE:*
(sign by entering your full name)
DATE:*