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Date of Application*
MM slash DD slash YYYY
Position you're Applying For*
Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email Address*
Are you age 18 or older?*
- Yes
- No
Have you ever worked for us before?*
- Yes
- No
Are you legally authorized to work in the United States?*
- Yes
- No
Availability
Available Start Date*
MM slash DD slash YYYY
Schedule you're willing to work*
- Full-time
- Part-time
- Temporary
- Permanent
What shift are you available?*
- 1st
- 2nd
Salary Required*
Work History
Name of Company #1
Position Held
Duties
Date you Started
MM slash DD slash YYYY
Date you Left
MM slash DD slash YYYY
Reason for Leaving
Name of Company #2
Position Held
Duties
Date you Started
MM slash DD slash YYYY
Date you Left
MM slash DD slash YYYY
Reason for Leaving
Name of Company #3
Position Held
Duties
Date you Started
MM slash DD slash YYYY
Date you Left
MM slash DD slash YYYY
Reason for Leaving
Education Information
Did you obtain a high school diploma or GED?*
- Yes
- No
School Name / City / State
Did you attend college?*
- Yes
- No
Type of Degree Obtained
- Associates
- Bachelors
- Masters
- Certification
School Name / City / State
Other Education (explain)
General Information
Special Skills or Experience
What business equipment can you operate?
What computer software programs are you proficient?
Can you perform the job with or without reasonable accommodations?*
- Yes
- No
Please read the following statements carefully.
General Notice*
I have read the General Notice.
Ace Manufacturing & Parts Company and Rokwell Industries welcome all qualified applicants without regard to their race, color, religion, gender, national origin, age, marital status, disability or other protected status. Please complete the application completely. Information provided will assist with the evaluation of your qualifications. All offers of employment are contingent upon successful completion of required post offer examinations including, but not limited to, drug screen, physical, criminal background check. Employment with Ace Mfg. & Parts Co. /Rokwell Industries is employment “at will”. This application and/or other human resources related forms provided to you do not constitute and employment contract.
At Will Statement*
I agree to the ‘At Will’ statement.
In consideration of my employment, I agree to conform to the policies and procedures of the company. I understand that in accepting this application, the company is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered. Furthermore, if employed, I understand that I am employed at will and that my employment and compensation can be terminated with or without cause, and with or without notice at any time.
Pre-Employment Testing Statement*
I agree to the ‘Pre-Employment Testing’ Statement.
I also understand that any offer of employment is contingent on successfully passing a physical exam and drug screen and pre-employment testing. I agree to refund the Company the cost of my physical exam and drug screen, if I fail to pass the drug screening, fail to report to work or resign or am terminated for any reason during the 90-calendar day probation period. I authorize a payroll deduction of that amount from my final paycheck.
Employment Statement*
I agree to the ‘Employment Statement’.
I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any falsified statements on this application or omission of the fact on either this application or during the pre-employment process will result in my application being rejected, or, if I am hired, in my employment being terminated.
Background Statement*
I agree to the ‘Background Statement’.
I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information, including criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my work and educational record and background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for releasing this information. I also understand that the use of illegal drugs is prohibited during employment.
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Please read the following statements carefully.

Ace Manufacturing & Parts Company

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