Personal Information

Position(s) Applying For

Email Address A value is required.Invalid format.

How were you referred to BRG Precision Products? Select One Advertisement Walk-in Friend Web Search Other

General Information

Date Available for Work Availability Select One Full Time Part-time Temporary Please select an item.

If you are under 18 years of age, can you provide the required proof of your eligibility to work? Select One Yes No Please select an item.

Have you ever been employed at BRG before? Select One Yes No Please select an item. If yes, please give date

Are you currently employed? Select One Yes No Please select an item. May we contact your current employer? Select One Yes No

For purposes of compliance with the Immigration Reform and Control Act, are you legally eligible to work in the United States? Select One Yes No Please select an item.

Under the Immigration Reform and Control Act of 1986, should you be employed you will be required to fill out a certification verifying that you are eligible to be employed and verifying your identity and provide documentation to the effect.

For reference purposes, have you worked or attended school under a former name? Select One Yes No Please select an item.

If yes, please list former names:

Have you ever been convicted of a crime? Select One Yes No Please select an item.

If yes, explain the number of convictions, nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:

Work History

Starting with your present or most recent job, describe all paid, military and applicable voluntary experience. Highlight you knowledge, skills and abilities which best demonstrate your qualifications for this position.

Name of Employer A value is required.

Dates Employed, From To

Address

Base Pay, Start Final

Phone Number Job Title

Name of Supervisor

Reason for leaving

Work Performed (List the Jobs you held, duties performed, skills used, advancements or promotions while you worked at the company.) Please limit response to 90 characters per line.

Name of Employer A value is required.

Dates Employed, From To

Address

Base Pay, Start Final

Phone Number Job Title

Name of Supervisor

Reason for leaving

Work Performed (List the Jobs you held, duties performed, skills used, advancements or promotions while you worked at the company.) Please limit response to 90 characters per line.

Name of Employer A value is required.

Dates Employed, From To

Address

Base Pay, Start Final

Phone Number Job Title

Name of Supervisor

Reason for leaving

Work Performed (List the Jobs you held, duties performed, skills used, advancements or promotions while you worked at the company.) Please limit response to 90 characters per line.

If you need additional space, please email or fax additional information.

Education

High School A value is required.

Years Completed Select One 9 10 11 12 Please select an item.  HS Diploma Select One Yes No GED Please select an item.
Major Course(s) of study A value is required.

Tech Sch. / Jr. College A value is required.
Years Completed Select One 1 2 Please select an item.   Degree Select One Yes No Certificate Please select an item.
Major Course(s) of study A value is required.

College
Years Completed Select One 1 2 3 4 4+ Please select an item.   Degree Select One Yes No Please select an item.
Major Course(s) of study

U.S. Military Service

Have you ever had any job-related training in the united States Military? Select One Yes No Please select an item.

If yes, please describe training / experience received:

Summarize Special Skills and Training not listed above:

Work performed (List the jobs you held, duties performed, skills used, advancements or promotions while you served our country.) Please limit response to 90 characters per line.

References

Name A value is required.  Bus. Phone A value is required.  Occupation A value is required.

Name A value is required.  Bus. Phone A value is required.  Occupation A value is required.

Name A value is required.  Bus. Phone A value is required.  Occupation A value is required.

Special Skills and Qualifications

Work Performed (List the Jobs you held, duties performed, skills used, advancements or promotions while you worked at the company.) Please limit response to 90 characters per line.

Notification and Agreement (Please read before signing)

I certify that the answers given herein are true, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.

Questions regarding this statement should be directed to the Human Resources Manager before signing. The application will be given every consideration, but its receipt does not imply that the applicant will be employed.

It is the policy of the company to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status, or pregnancy, and to afford equal opportunities to disabled veterans, veterans of the Vietnam era, and individuals with a disability and any other characteristic protected by Federal, State or Local law.

I authorize you to communicate with persons listed as references, former employers, and any others with whom you desire to check as may be necessary in arriving at an employment decision. I release from all liability anyone supplying such information and I also release the employer from all liability that might result from making an investigation.

If hired, I agree to abide by all of the company rules and regulation, and understand that, if employed, my employment may be terminated with or without cause, and with or without notice, at any time, at the option of either the company or myself. I further understand that no representation, whether oral or written by any representative or agent of the Company, at any time, can constitute a contract of employment. I understand that the Company shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, benefits or other terms or conditions of employment. No representative or agent of the Company has the authority to enter into any agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other term or condition of employment other than in a document signed by the General Manager, or to make any agreement contrary to the foregoing.

I understand that if offered a position with BRG Precision Products, Inc., I may be required to submit to a pre-employment medical examination, drug screening and background check as a condition of employment. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to affect the results of these pre-employment tests, checks will result the withdrawal of any employment offer or termination of employment if already employed.

I understand this application will be considered current for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application.

I acknowledge that I have read and understand the above statements and hereby grant permission to confirm the information supplied on this application by me.

Applicant Signature A value is required.    Date A value is required.Invalid format.