Thank you for expressing an interest in employment with Curtis Products, Inc. Curtis Products, Inc. is an Equal Opportunity Employer, offering job opportunities and advancement on an equal basis to all qualified persons regardless of race, sex, religion, age color, national origin, citizenship status, physical or even mental disability, or veteran status. This application is effective for one year from the date of application. If you are still available after that time, you must reapply. Failure to fully complete this application may result in non-consideration. Fields marked with an asterisk (*) are required. Date Name* First Middle Last Current Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Daytime Phone*Position Applied For (Only list one position) Name of person who referred you (If applicable) Type of Work Desired* Full-Time Part-Time Shift Desired* First Shift Second Shift High SchoolName* Did you graduate?* Yes No Degree/Diploma/Certificate Grade Point Average Major Course of Study Technical, Vocational, Business TrainingName Did you graduate? Yes No Degree/Diploma/Certificate Grade Point Average Major Course of Study College or UniversityName Did you graduate? Yes No Degree/Diploma/Certificate Grade Point Average Major Course of Study Additional Educational ExperiencesEmployment History1. Present Employer or Most Recent EmployerCompany Name Company NamePhone NumberPhone NumberLocation Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name Supervisor NameDates of EmploymentFrom Date Month Day Year To DateTo Date Month Day Year SalaryFrom ToTo Job Titles & DutiesReason For Leaving May we contact this employer? Yes No 2. Former EmployerCompany Name Company NamePhone NumberPhone NumberLocation Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name Supervisor NameDates of EmploymentFrom Date Month Day Year To DateTo Date Month Day Year SalaryFrom ToTo Job Titles & DutiesReason For Leaving May we contact this employer? Yes No 3. Former EmployerCompany Name Company NamePhone NumberPhone NumberLocation Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name Supervisor NameDates of EmploymentFrom Date Month Day Year To DateTo Date Month Day Year SalaryFrom ToTo Job Titles & DutiesReason For Leaving May we contact this employer? Yes No Other Job Related ExperienceSome people gain job related experience in positions other than as an employee. For instance, a manager may gain experience while working on civil projects, in school organizations or in PTA activities. Please list and describe any paid or unpaid activities, honors, experience, or training which might aid you in performing the job(s) for which you may have applied, and have not listed previously in this application. (You may omit any activities, honors, or other items that tend to identify your race, sex, religion, national origin, age, disability, or other personal traits that you prefer not to disclose.)Additional InformationPlease add any additional information (except, at your option, that which identifies your race, sex, religion, national origin, age, disability, or other non-job-related personal information) that you think may be relevant to the decision to hire you.Periods of UnemploymentPlease account for any time you were not employed after leaving school in the past 10 years. (You need not list any unemployment periods of six weeks or less).General Information1. Have you ever applied for a job with this company in the past?* Yes No If yes, date that you applied Month Day Year Name on the application First Last Position applied For 2. Has this company ever employed you in the past?* Yes No If yes, dates of employmentFrom Date Month Day Year To DateTo Date Month Day Year Name while employed (If different from your present name) First Last Position(s) held during previous employmentReason you left If hired, will you be able to work the scheduled days and hours required for the position(s) for which you are applying?* Yes No If hired, can you furnish proof that you are at least 18 years of age?* Yes No If no, please explainDo you have any commitments to another employer that might affect your employment with our company?* Yes No If yes, please explainIf hired, can you furnish proof that you are eligible to work in the United States? (If unsure of the documents needed to prove eligibility to work in the U.S. , we will be happy to explain the legal requirements).* Yes No If no, please explainPlease read carefully and initial each paragraph before signing.By my signature and initials placed below, I certify that the information provided in this employment application (and accompanying resume, if any) is true and complete, and I understand that any false information or significant omissions may disqualify me from further consideration for employment, and may be justification for my dismissal from employment, if discovered at a later date.I authorize any person, school, current employer, past employer(s), and organizations named in this application form (and accompanying resume, if any) to provide this company with relevant information and opinions that may be useful to the company in making a hiring decision, and I release such persons and organizations from any legal liability in making such statements.Initials* A drug test and criminal background check will be required. I understand that any offer of employment may be withdrawn if I test positive for drugs and/or if a condition is discovered for which no reasonable accommodation can be made.Initials* I understand that neither this application nor any other offer of employment, which results, creates nor is intended to create a contract of employment. I understand that, if hired, my employment is for no definite period of time and may be terminated at any time, with or without cause and with or without notice. I also understand that no person is authorized to change any of the terms mentioned in this employment application from except the President. Any such change, to be valid, must be in writing and signed by him/her.Initials* Full Name* Date* PLEASE REVIEW YOUR APPLICATION AND ENSURE ALL INFORMATION IS CORRECTCAPTCHA