Structural Designer | Indianapolis, IN

Date of Application

Position Applied For

Department

First Name*

Last Name*

Address*

City*

State*

Zip*

Phone (home/cell)*

Work Phone (if we may contact you there)

Email*

Location

If you have ever worked under another name, please state what name(s) and when:

If you are under 18 years of age, do you have a work permit?

Yes

Are you employed now?

Yes

How did you learn of this job opening?*

If employed, on what date would you be available for work?

Are you willing to work any shift?

Yes

Are there any days of the week when you would not be available to work? Please specify.

Have you filed an application here before?

Yes

If yes, give date:

Are you on layoff and subject to recall?

Yes

Do you have, or have you applied for, the legal right to work in the United States?

Yes

Have you ever been convicted of a crime other than a minor traffic violation?

Yes

If yes, please explain:

EDUCATION

High School Name & Location

Number of Years Attended (High School)

Did you graduate? (High School)

Yes

Course of Study (High School)

College Name & Location

Number of Years Attended (College)

Did you Graduate? (College)

Yes

Degree or Diploma (College)

Yes

Course of Study (Degree Achieved or Studied)

Name and Location of Trade, Business or Additional School

Number of Years Attended

Did you graduate?

Yes

Degree / Diploma / Certification

Yes

Course of Study (Trade, Business & Additional )

If you expect to complete an educational program in the near future, please indicate what type of degree or program:

Expected Completion Date

EXPERIENCE

Current Employment

May we contact your present employer?

Yes

Job Title

Employer

Employer Address

Employer Phone

Type of Business

Immediate Supervisor / Title

From Date

To Date

Type of Job

Full Time

Part Time

Will you receive a satisfactory reference from this employer?

Yes

If “No,” please explain:

Duties

Number of Employees You Supervised

Equipment Used

Reason for Leaving

Past Employment - 1

Job Title

Employer

Employer Address

Employer Phone

Type of Business

Immediate Supervisor / Title

From Date

To Date

Type of Job

Full Time

Part Time

Will you receive a satisfactory reference from this employer?

Yes

If “No,” please explain:

Duties

Number of Employees You Supervised

Equipment Used

Reason for Leaving

Past Employment - 2

Employer

Job Title

Employer Address

Employer Phone

Type of Business

Immediate Supervisor / Title

To Date

From Date

Type of Job

Full Time

Part Time

Will you receive a satisfactory reference from this employer?

Yes

If “No,” please explain:

Duties

Number of Employees You Supervised

Equipment Used

Reason for Leaving

Use this space for any additional information you think would help us evaluate your application, including training, seminars, workshops and special achievements or specialized skills:

REFERENCES

To assist us in evaluating your qualifications, give the names and contact information of three business or professional people, not friends or relatives, familiar with your work record and performance.

References

Reference Name

Reference Address

Telephone

Relationship

Length of Time Known

MISCELLANEOUS

Are you willing to accept employment that requires you to travel?

Yes

If yes:

During the day only

Occasionally overnight

Frequently overnight

Are you willing to work overtime?

Yes

State names of relatives and friends working for us:

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STATEMENT OF COMPANY POLICY

Buckeye Corrugated, Inc. is committed to providing equal employment opportunity to all employees and applicants regardless of a person’s race, religion, color, national origin, gender, age, military or veteran status, citizenship, genetic information, disability, or other class protected by applicable law.

CERTIFICATION AND AUTHORIZATION

Please read the following paragraphs carefully.

By signing below, 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 the Company, would affect my application unfavorably.

If I am hired by the Company, and if the Company 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.

If offered a position, I agree to submit to a post-offer, pre-employment physical examination and testing for illegal drugs,including medical marijuana, prior to beginning work with the Company and understand that a confirmed positive test will form the basis for rescission of any job offer. I understand that if I am employed by the Company, I may be required, when job related and consistent with the Company’s business needs, to undergo a medical examination or testing for alcohol. I further understand that I may be required to submit to a test for the use of illegal drugs at any time.

In consideration of my employment with the Company, I agree to abide by all the Company’s rules, policies, and regulations.

I understand that nothing in this employment application creates a contract of employment between me and the Company. If I am hired by the Company, my employment and compensation are “at will,” which means that my employment can be terminated, either by the Company 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, which is not an atwill agreement. As a general rule, Buckeye Corrugated, Inc. does not use employment agreements; however, in the event one is required, only the President of Buckeye Corrugated, Inc. has the authority to enter into an employment agreement with me for any specified period of time, and such must be in writing.

In the event of personal indebtedness to the Company, I authorize the Company to withhold from my wages such amounts as permitted by law to satisfy my obligation to the Company.

I give the Company my permission to conduct any investigation regarding the information contained in my employment application, including through the use of any third party credit reporting agency, which the Company thinks is necessary to determine my qualifications for assuming a job with the Company. I give the Company 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 the Company whatever information they have about me. I also unconditionally release all named and unnamed sources from any and all liability that might result from furnishing any information about me.

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