F HR 004 Employment Application
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Transcript of F HR 004 Employment Application
Galloway CompanyEmployment Application Page 1 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
EMPLOYMENT APPLICATIONGalloway Company 601 South Commercial Street, Neenah, WI 54956 Phone (920) 722-8903 Fax (920) 722-1927
Personal InformationLast Name First Name M.I. Date
Address Driver’s License #
City Zip Code Home Phone
Email Address Other Phone
Positions Applied For: (PLEASE CHECK ONE)Clerical (Specify) Production Worker
Professional (Specify) Technical (Specify)
Managerial (Specify) Other (Specify)
Available:Year Round ______Summer Only ______
Office Use Only:
Contacted: _____________________ Interviewed: ________________________________
Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
If you require any reasonable accommodation to complete this form or any part of the application or selection process, please contact the Personnel Office at 920-722-7741 or fax 920-722-1927. Thank you.
Education & Training:
Galloway CompanyEmployment Application Page 2 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
Education: Elementary High School College/University Post GradSchool Name City, State
Years Completed
Diploma/Degree
Specialized Training, Skills, Extra-Curricular Activities
Character References:Please list (3) persons not related to you, that have known you for at least (6) months, and have knowledge of your character, experience, and ability.Name Occupation
Home Address Business Address
City, State, Zip City, State, Zip
Home/Cell Phone Business Phone
Name Occupation
Home Address Business Address
City, State, Zip City, State, Zip
Home/Cell Phone Business Phone
Name Occupation
Home Address Business Address
City, State, Zip City, State, Zip
Home/Cell Phone Business Phone
Galloway CompanyEmployment Application Page 3 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
EMPLOYMENT EXPERIENCE:Please start with your present of most recent job first.Employer Duties Performed:
Address
City, State, Zip
Job Title
Supervisor
Reason for Leaving
Dates Employed:
Hourly Rate/Salary: May we contact this employer for references?
Employer Duties Performed:
Address
City, State, Zip
Job Title
Supervisor
Reason for Leaving
Dates Employed:
Hourly Rate/Salary: May we contact this employer for references?
Galloway CompanyEmployment Application Page 4 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
EMPLOYMENT EXPERIENCE CONTINUED:Employer Duties Performed:
Address
City, State, Zip
Job Title
Supervisor
Reason for Leaving
Dates Employed:
Hourly Rate/Salary: May we contact this employer for references?
Employer Duties Performed:
Address
City, State, Zip
Job Title
Supervisor
Reason for Leaving
Dates Employed:
Hourly Rate/Salary: May we contact this employer for references?
Please use additional pages if needed.
Please answer the following questions:
Galloway CompanyEmployment Application Page 5 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
Are you 18 years old or over? YES NO
Are you currently employed? YES NO
Are you on layoff, subject to recall?
YES NO
Have you ever been discharged from any position? If yes, state facts & penalty. NO
Have you been convicted of a felony?If yes, state facts & penalty. NO
Do you have friends or family who work for Galloway Company?
If yes, please name employee and state relationship.NO
Are you legally eligible for employment in this country?
YES NO
Are you able to meet the attendance requirements for the position?
YES NO
Will you work overtime if required?
YES NO
Have you ever been employed at Galloway Company before?
YES NO
Date available for work?
NOTICE:Some of the positions at Galloway Company are filled using various selection tests.If the position for which you have applied is filled utilizing selection test, you will receive notice of the time, date, and place. If you require special accommodation, please contact the Personnel Office at (920) 722-7741 at least (7) days prior to the test.
Galloway CompanyVoluntary Affirmative Action Information
Galloway CompanyEmployment Application Page 6 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
Galloway Company is required by State and Federal employment regulations to keep records and make reports to the Equal Employment Opportunity Commission. By answering the questions below, you will assist us in our
reporting requirements. The information is voluntary and will be collected and used for statistical purposes only.
This form will be filed separately from your application and will not be used to discriminate in any way in the employment process.
Name: Date:
Male / Female Position applying for:
ETHIC ORIGIN: Please circle one Hispanic Black White American Indian /Alaskan Native Asian/ Pacific Islander
SPECIAL NOTICE TO VIETNAM ERA VETERANS, DISABLED VETERANS, AND INDIVIDUALS WITH PHYSICAL OR MENTAL DISABILITIES:
Government contractors subject to Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and qualified handicapped individuals.
You are invited to volunteer this information, if you qualify, to assist in proper placement and determining reasonable accommodation. This information will be considered confidential, and refusal to provide this information will not adversely affect your consideration for employment.
IF YOU WISH TO BE IDENTIFIED, PLEASE CIRCLE IF ANY OF THE FOLLOWING ARE APPLICABLE: VIETNAM VETERAN DISABLED VETERAN HANDICAPPED INDIVIDUAL
How did you hear about the job in which you are applying? Please circle all that apply.
Employee or Relative School Employment Agency AdvertisementOther ( Please Explain)______________________________________________________________________________________________________________________
This form is to be completed by applicant - Not for interview purposes - to be filed separately from application.This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or necessitated
by another federal law or regulation.
Please list any additional information you would like us to consider:
Galloway CompanyEmployment Application Page 7 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
It is understood and agreed upon that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or discharge from the Galloway Company’s service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, Galloway Company reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of Galloway Company has the authority to make any assurances to the contrary.
I give the Galloway Company the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Galloway Company and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information.
Galloway Company is an Equal Opportunity Employer. Galloway Company does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, state or federal law.
This application is current for (1) year. At the conclusion of that time, if I have not heard from the Galloway Company and still wish to be considered for any reported openings, it will be necessary to fill out a new application.
____________________________________ ____________________________Signature of Applicant Date
Situation Questions
Galloway CompanyEmployment Application Page 8 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
1. Describe a situation where you had to make a decision but you did not have all the information you needed.
2. Describe a situation where you found an error in your work. What was the cause? How was it handled?
3. Give an example of a time when you were given a task to accomplish without advance warning.
4. Give a specific example of doing more than required in one of your previous jobs.
5. Describe a situation where you wished you had acted differently with someone at work. What did you do? What happened as a result?
6. Describe a time when you organized your thoughts on a matter of importance to you, and in communicating these to others; you felt you got you points across well.
7. Describe a time when you brought together a group of people to work with each other in some activity or project?
Galloway CompanyEmployment Application Page 9 of 9F-HR-004-C 9/18/2012
This document contains trade secret/confidential commercial information pursuant to 5 U.S.C 552(b)(4)
8. Describe a time when you set your sights on a high, demanding goal and achieved it.
9. Give an example of a new idea that you came up with that made a significant contribution to the success of some activity or project.
10. Give an example of an experience where you came to be regarded by other people as a person who could be trusted to listen to them and treat them fairly.
11. Give examples of your involvement in safety and wellness programs at your previous positions.
___________________________________Print Name
____________________________________Signature