United Fire Application For Employment

Application For Employment

United Fire Equipment Company is an Equal Opportunity Employer
and is committed to maintaining a drug-free workplace.

This application must be completed in full, even if we already have a resume from you.
Please do not leave any fields blank. Incomplete applications will not be considered.

PERSONAL INFORMATION

Last Name	First	Middle Name
Email	Home Phone	Cell
Present Address:
Street	City	State Zip
Permanent Address (if other than above):
Street	City	State Zip

Position Applying for

If you are not applying for a specific position, indicate "OPEN" in the field.

What date are you available for work?

Full-time   Part-time   Temporary

If part-time, indicate hours or days available

If Temporary, indicate dates available

Indicate hours you will work:
Days   Evenings   On Call

Will you work weekends if needed? Yes   No

Indicate days you are available to work:
Sunday   Monday   Tuesday   Wednesday   Thursday   Friday   Saturday

If you are under 18 years of age, can you provide required proof of your eligibility to work? Yes    No

Are you a military veteran? Yes    No      If yes, please list under Work Experience (below).

Do you have any commitments to another employer that might affect your employment with us? Yes No
If yes, please specify

What is your minimum weekly salary requirement? (This field must be completed)

How did you learn about this position opening (check all that apply)?
Employee Referral - Name of Employee
Internet - Name of Web Site:
Newspaper Ad - Name of Newspaper:
Friend
Other

Have you any relatives employed here? Yes    No
If yes, please indicate name(s)

Have you been previously employed here? Yes    No
If yes, give dates

Have you ever been convicted of a felony, or a crime other than a minor traffic offense?
(An affirmative answer will not automatically disqualify you as a candidate for employment)
Yes    No
If yes, explain fully, including dates

Skills and Experience:
List training and/or experience which may qualify you for the position(s) desired:

Check "T" if you have training in the skill Check "E" if you have experience in the skill Check "B" if you have both training and experience		Proficiency Level:
T E B	Microsoft Word	High Med Low
T E B	Microsoft Excel	High Med Low
T E B	Microsoft Publisher	High Med Low
T E B	Microsoft PowerPoint	High Med Low
T E B	Microsoft Access	High Med Low
T E B	Gold Mine Sales & Marketing	High Med Low
T E B	Navision Accounting Software	High Med Low
T E B	Email	Frequent User Infrequent User
T E B	Internet	Frequent User Infrequent User
T E B	Typing	wpm
T E B	Data Entry	speed
T E B	Supervision/Leadership	Yrs of experience
T E B	Management	Yrs of experience
T E B	Customer Service	Yrs of experience
T E B	Sales	Yrs of experience
T E B	Human Resources	Yrs of experience
T E B	Accounting	Yrs of experience
T E B	Invoicing/Inventory	Yrs of experience
T E B	Purchasing	Yrs of experience

Other:

Comments
Please enter any additional work experience or skill information you would like us to consider in this section.

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

Language 1
Read/Write/Speak	Read/Write	Read/Speak	Read Only	Speak Only

Language 2
Read/Write/Speak	Read/Write	Read/Speak	Read Only	Speak Only

Language 3
Read/Write/Speak	Read/Write	Read/Speak	Read Only	Speak Only

Job Performance Ability
Given your knowledge, skills, education, are you able to perform all the essential functions of the position for which you are applying, with or without reasonable accommodation, as set forth in the job description?
Yes No

Do you now have or do you anticipate having any activities, commitments, or responsibilities that may prevent you from short-term traveling if required? Yes No
If yes, please explain

Education
High School
Name of School	Location (City, State)	Diploma or GED
1		Yes No
2		Yes No
College or Schools after High School (include any job-related education or training in military services)
Name of School	Location (City, State)	Academic Major, Skill, or Trade	Dates Attended (ex. Sept 1999)	Did you graduate?
1				Yes No
2				Yes No
3				Yes No
4				Yes No

Work Experience
List most recent employer first. Include at least the past ten (10) years, and account for any time gaps in your employment history, including any military service. All fields must be completed. "See resume" is not acceptable.

1.	Name of Employer	Location (City, State)
	Dates employed (ex. Sept 1999) From To	Final Salary Select one Hourly Weekly Annually Commission
	Your last job title & description
	Name under which employed
	Name of supervisor	Phone Number (123-456-7890)
	Reason for leaving May we contact? Yes No

2.	Name of Employer	Location (City, State)
	Dates employed (ex. Sept 1999) From To	Final Salary Select one Hourly Weekly Annually Commission
	Your last job title & description
	Name under which employed
	Name of supervisor	Phone Number (123-456-7890)
	Reason for leaving May we contact? Yes No

3.	Name of Employer	Location (City, State)
	Dates employed (ex. Sept 1999) From To	Final Salary Select one Hourly Weekly Annually Commission
	Your last job title & description
	Name under which employed
	Name of supervisor	Phone Number (123-456-7890)
	Reason for leaving May we contact? Yes No

4.	Name of Employer	Location (City, State)
	Dates employed (ex. Sept 1999) From To	Final Salary Select one Hourly Weekly Annually Commission
	Your last job title & description
	Name under which employed
	Name of supervisor	Phone Number (123-456-7890)
	Reason for leaving May we contact? Yes No

I certify that the information set forth in this Application for Employment is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application or failure to furnish all requested information shall be considered sufficient cause for my dismissal.

I further understand that if I am hired there is no employment contract, that I may be terminated or laid off at any time, with or without notice at the will of the employer, that any verbal statements of any person to the contrary are void, and that an employment contract may be made only in writing by the company President or specified authorized official of the company. I authorize United Fire Equipment Company to investigate any information contained in this application for employment, to contact my former employers, and to conduct a background investigation. I further understand that my employment is contingent upon a satisfactory pre-employment drug screening test result and satisfactory results from any background investigations conducted.

I understand that my employment shall be contingent upon proof of identity and verification of eligibility for employment in the United States in accordance with the Immigration Reform and Control Act of 1986.

United Fire provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. This policy applies to all terms and conditions of employment, including but not limited to hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

United Fire Equipment Company expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status. Improper interference with the ability of United Fire's employees to perform their expected job duties is absolutely not tolerated.

I consent to and authorize this employer and its personnel to request any information concerning my previous employment record as indicated on the Application for Employment. I hereby release all parties and persons connected with any request for information from all claims, liabilities, and damages, for whatever reason, arising out of furnishing such job-related information.