Superior Maintenance Company, Inc.
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Name
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Last
Phone
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Address
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Street Address
Address Line 2
City
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If yes, please give dates of employment.
Have you ever been employed by SMC in the past?
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Yes
No
Are you legally eligible for employment in the US?
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Date Available to start?
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Shift Desired?
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First
Second
Third
Type of Employment Desired
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Full Time
Part Time
Temporary
Educational Co-Op
Employment History 1 of 2
Employer
Date Started
Date Ended
Phone
Job Title
Summarize nature of work performed and job responsibilities
Supervisors name and title
Reason for leaving
Hourly/Salary Rate
Employment History 2 of 2
Employer
Date Started
Date Ended
Phone
Job Title
Summarize nature of work performed and job responsibilities
Supervisors name and title
Reason for leaving
Hourly/Salary Rate
Skills and Qualifications
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Education
Highest Grade Level Completed
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1-8
9-12
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High School Name and Location
Did you Graduate?
Yes
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Grades completed
Freshman
Sophmore
Junior
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College Name and Location
Course of Study
Number of years attended
Did you Graduate?
Yes
No
Other Name and Location
Course of Study
References
Reference 1
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Reference 1 Telephone
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Reference 1 Years Known
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Reference 2
Reference 2 Telephone
Reference 2 Years Known
Reference 3
Reference 3 Telephone
Reference 3 Years Known
Terms
I UNDERSTAND THAT IF I AM EMPLOYED, ANY MISREPRESENTATION OF MATERIAL, OMISSION MADE BY ME ON THIS APPLICATION WILL BE SUFFICIENT CAUSE FOR CANCELLATION OF THIS APPLICATION OR IMMEDIATE DISCHARGE FROM THE EMPLOYER'S SERVICE., WHENEVER IT IS DISCOVERED. I GIVE THE EMPLOYER THE RIGHT TO CONTACT AND OBTAIN INFORMATION FROM ALL REFERENCES, EMPLOYERS, EDUCATIONAL INSTITUTIONS AND TO OTHERWISE VERIFY THE ACCURACY OF THE INFORMATION CONTAINED IN THIS APPLICATION. I HEREBY RELEASE FROM LIABILITY THE EMPLOYER AND ITS REPRESENTATIVES FOR SEEKING, GATHERING AND USING SUCH INFORMATION AND ALL OTHER PERSONS, CORPORATIONS OR ORGANIZATIONS FOR FURNISHING SUCH INFORMATION. SMC DOES NOT DISCRIMINATE IN RECRUITMENT, APPOINTMENT, PROMOTION, PAYMENT, TRAINING, OR OTHER EMPLOYMENT PRACTICES AGAINST ANYONE BECAUSE OF RACE, ETHNIC ORIGIN, SEX, SEXUAL ORIENTATION, COLOR, CREED, RELIGION, AGE (40 OR OVER), POLITICAL BELIEF, NATIONAL ORIGIN OR SMOKING. THIS APPLICATION IS CURRENT FOR 60 DAYS. AT THE CONCLUSION OF THIS TIME, IF I HAVE NOT HEARD FROM THE EMPLOYER AND STILL WISH TO BE CONSIDERED FOR EMPLOYMENT, IT WILL BE NECESSARY TO FILL OUT A NEW APPLICATION. THIS APPLICATION DOES NOT CONSTITUTE AN AGREEMENT OR CONTRACT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OR DEFINITE DURATION. I UNDERSTAND THAT NO REPRESENTATIVE OF THE EMPLOYER, OTHER THAN AN AUTHORIZED OFFICER, HAS THE AUTHORITY TO MAKE ANY ASSURANCES TO THE CONTRARY. I FURTHER UNDERSTAND THAT ANY SUCH ASSURANCE MUST BE IN WRITING AND SIGNED BY AN AUTHORIZED OFFICER. I FURTHER UNDERSTAND THAT KENTUCKY IS AN EMPLOYMENT AT WILL STATE AND SMC WILL BE GOVERNED AS SUCH. I UNDERSTAND IT IS THIS COMPANY'S POLICY NOT TO REFUSE TO HIRE A QUALIFIED INDIVIDUAL WITH A DISABILITY BECAUSE OF THAT PERSON'S NEED FOR REASONABLE ACCOMMODATION AS REQUIRED BY THE ADA. I ALSO UNDERSTAND THAT IF I AM HIRED, I WILL BE REQUIRED TO PROVIDE PROOF OF IDENTITY AND LEGAL WORK AUTHORIZATION. I ALSO UNDERSTAND THAT I MAY BE REQUIRED TO SUBMIT TO DRUG TESTING, PHYSICAL EXAM and or BACKGROUND INVESTIGATION, IF APPLICABLE. FURTHERMORE, I AUTHORIZE THE RELEASE OF THE RESULTS OF TESTS AND EXAMINATIONS TO SMC OR ANY OF ITS REPRESENTATIVES. BY THIS AUTHORIZATION, I DO HEREBY RELEASE ANY DOCTOR, MEDICAL PERSONNEL, HOSPITAL, MEDICAL CENTER, CLINIC, LABORATORY, SMC, OR ANY OF ITS REPRESENTATIVES FROM ANY AND ALL LIABILITIES ARISING FROM THE RELEASE OF THE INFORMATION AND MY SUBMITTING DENOTES SUCH CONSENT. I represent a warrant that I have read and fully understand the foregoing and seek employment under these conditions.
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I have read and agree to the terms and conditions.
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