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Employment Application

Employment Applicationadmin2019-05-30T16:04:14+00:00
  • Applicant Information

  • Position(s) Applied for

  • Which division are you interested in working with?
  • Not required
  • MM slash DD slash YYYY
  • U.S. Armed Forces Service

  • Education

  • Prior Work Experience

    Please list your most recent employment first, use additional space below if necessary to list additional employers.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Employer 2

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Employer 3

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Business References

    List only those persons who held managerial positions in the company you were employed at during the time of your employment.
  • Reference 2

  • Reference 3

  • Reference 4


    I certify that all statements on this Application for Employment are complete and truthful and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed and may result in my dismissal.

    I authorize the references listed in this Application for Employment, and any prior employer, educational institution, or any other persons or organizations to give this Company any and all information concerning my previous employment / education accomplishments, disciplinary information or any other pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I hereby waive written notice that employment information is being provided by any person or organization.

    If I am hired, in consideration of my employment, I agree to abide by the rules and policies of this Company, including any changes made from time to time, and agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I understand that no manager or other representative of the Company, other than the President, has any authority to enter into any agreement for employment for any specific or indefinite period of time, or to make any agreement contrary to the foregoing. Any such agreement made by the President must be made in writing to be effective.

    If I am selected for hire, I will be offered employment provided I verify that I am authorized to work as required by the Immigration Reform and Control Act of 1986.

    If I have a mental or physical disability and require an accommodation to perform the job, I must notify the Company of that need in writing within 182 days after I know or reasonably should have known that an accommodation was needed. Failure to do so will bar me from alleging that the Company has not accommodated me as required by law.

    I authorize the Company to secure my criminal conviction history. I agree to execute the appropriate authorization if necessary to obtain such information.

    Following a conditional job offer, I also authorize Jergens or its designated agent(s) to withdraw specimen(s) of my blood, urine, hair and/ or other substances for chemical analysis. One purpose of this analysis is to determine or exclude the presence of alcohol, drugs or other substances. I understand that decisions concerning my employment may be made as a result of these tests. b. I agree and understand, upon acceptance of an offered position with Jergens, the offer is contingent upon successful results from a background check and drug testing. If I decide not to join Jergens after the background check and drug testing have been Completed, I agree and understand I am responsible for these cost incurred on my behalf and will reimburse Jergens immediately.

    a. I understand that my application will be considered pursuant to the Company's normal procedures for a period of thirty (30) days. If I am still interested in employment thereafter, I must reapply. b. I agree that if any of the above commitments is ever found to be legally unenforceable as written, the particular commitment concerned shall be limited to allow its enforcement as far as legally possible. c. I have read, understand, and agree to items 1 through 8 above. I knowingly and voluntarily acknowledge that with my signature (in typed format) below.
  • Please type your full name as your signature
  • MM slash DD slash YYYY
  • Emergency Contact Information

  • This field is for validation purposes and should be left unchanged.

Links

  • TERMS & CONDITIONS

Services

  • PIPING
  • INSULATION SERVICES
  • MILLWRIGHT SERVICES
  • HEATING AND AIR
  • REMOVABLE COVERS
  • PAINTING & BLASTING
  • AUTOMOTIVE REPAIR
  • BUILDING & REMODELING

Contact Us

Address:
21030 M-60
Mendon, MI 49072

Phone: 269.496.7030
Fax:
 269.496.7558

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