EMPLOYMENT APPLICATION
Drug-Free Work Environment

 

It is Boomerang Rubber’s policy to provide equal employment  opportunity with regard to all terms and conditions ofemployment. Boomerang Rubber complies with federal and state laws prohibiting discrimination on the basis ofrace, color, religion, creed, national origin, disability, veteran status, military status, age, genetic  informationand/or other protected characteristics.

 
Employment requires a pre-employment drug screen test.
 
Applicant First Name*
 
 
Applicant Last Name*
 
 
Last four digits of Social Security Number
 
 
Mailing Address
 
 
Phone
 
 
City
 
 
State/Providence
 
 
ZipCode
 
 
Email Address*
 
 
Birth Month and Day (not year)
 
 
What is your preferred shift?
 
1st
 
 
2nd
 
 
3rd
 
 
Please check position(s) of interest:
 
Processing-Mill
 
 
Press Room
 
 
Shipping Associate
 
 
Processing - STAT
 
 
Finishing - Packaging
 
 
Maintenance
 
 
PIT (Forklift)
 
 
Tool and Die
 
 
Office - Clerical
 
 
Professional
 
 
 
 
Please check the best response for each question.
 

Have you been previously employed by Boomerang Rubber either directly or thorugh a staffing agency?

 
Yes I am a previous employee
 
 
No - I have never been employed by Boomerang
 
 

Do you have the legal right to be employed in the U.S.?

 
Yes, I can be legally employed in the US
 
 
No - I don't have legal employment status.
 
 
Are you at least 18 years of age?
 
Yes I am at least 18 years of age
 
 
No, I am not yet 18 years old
 
 

Do you have reliable transportation to and from work?

 
Yes I have reliable transportation to and from work
 
 
No - I don't have reliable transportation
 
 
Do you have a valid driver’s license?
 
Yes, I have a valid drivers license
 
 
No, I do not have a valid drivers license.
 
 
How did you learn about Boomerang Rubber?
 
Walk-In
 
 
Newspaper
 
 
 
Job Fair
 
 
Date
 
 
Staffing Agency
 
 
Agency Name
 
 
Friend or Relative
 
 
First Name
 
 
Last Name
 
 
EDUCATION
 
High School
 
 
College
 
 
List Software you have used:
 
 
List Manufacturing Work Experience
 
 
List Leadership Roles you have held:
 
 
Provide at least a 4-year employment history.
List the most recent employment first.
 
Employer 1 Name, City and State
 
 
Business Phone
 
 
Dates
 
 
Position 1
 
 
Final Wage
 
 
 
Employer 2 Name, City and State
 
 
Business Phone 2
 
 
Dates 2
 
 
Position 2
 
 
Final Wage 2
 
 
 
Employer 3 Name, City and State
 
 
Business Phone 3
 
 
Dates 3
 
 
Position 3
 
 
Final Wage 3
 
 
Describe a time when you lacked ability or knowledge to complete a work assignment. What did you do?
 
 
Describe a workplace policy that you did not like. How did you deal with it?
 
 
Explain how your knowledge, skills, education can be applied in a work environment.
 
 
Describe a time when you learned something by reading.
 
 
Describe a time when you learned something by doing.
 
 
Describe your ideal job.
 
 
 

I certify that all information submitted by me on this application is true and complete. I understand that if any false information,omissions, or misrepresentations are discovered, my application may be rejected; if I am employed at time of discovery, my employment may be terminated.


In consideration for employment, I agree to abide by the company’s policies, procedures and to adhere to safe work practices. I agree that my employment and compensation can be terminated, with or without cause and with or withoutnotice, at any time, at either the company’s option or mine (at-will employment). I understand that the termsand conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the com-pany. (initial) I understand that no company representative, other than its General Manager, and then only when inwriting and signed by the General Manager, has any authority to enter into any agreement for employment for any specific pe-riod of time, or to make any agreement contrary to the foregoing.

 
E-Signature*