U.S. Military Experience This Section Is Voluntary

Personal Information

Last Name / First Name / MI / TODAY’S Date
Street Address / City / State / Zip
Enter only last 4 digits of Social Security Number / Email Address (important/will be required upon any offer of employment)
Home Phone No. / Cell Phone No.
How did you hear about this position opening?
(e.g., friend, radio, name of newspaper or online job board?)
Have you worked for, or applied to, our company before? / Yes / No / Month/Year / Location
Are you 18 years or older? / Yes / No
Are you eligible to work in the United States? / Yes / No
Position desired/applying for
Mill location desired
What is your minimum salary requirement
Type of work schedule desired / Full Time Part Time Summer Student Temporary
Can you work overtime (if applicable)? / Yes / No
Can you work rotating shifts (if applicable)? / Yes / No
Are you willing to travel (if applicable)? / Yes / No
Are you capable of performing all essential job functions/tasks of the position(s) for which you are applying with or without reasonable accommodations? / Yes / No
What date are you available for work?

Education

School Name, Address, Phone / Degree Type / Major / Graduate? (Yes/No)
High School / Name / Yes
No
Address
City, State / Area Code / Phone #
List AccreditedTechnical, Undergraduate,
& Graduate Education / Name / Yes
No
Address
City, State / Area Code / Phone #
Name / Yes
No
Address
City, State / Area Code / Phone #
Name / Yes
No
Address
City, State / Area Code / Phone #
Other Applicable Education / Name / Yes
No
Address
City, State / Area Code / Phone #

Employment History- Please do not use “See Resume.” Provide complete information so we can efficiently process your application.

Start with Most Recent Employer / Employment Dates / Position Held / Ending Salary/Rate / Immediate Supervisor / May we contact? / Reason for Leaving
Company Name
Address
City, State / Area Code / Phone #
Name
Address
City, State / Area Code / Phone #
Name
Address
City, State / Area Code / Phone #
Name
Address
City, State / Area Code / Phone #

U.S. Military Experience – this section is voluntary

Branch / Date Entered / Date Discharged
Duties or Special Training

References- Please do not use “See Resume.” Provide 3 business, professional, or academic references or list 4 personal references.

Type of Reference
(Personal, Professional, Academic) / Name / Phone / Position

Other Job-Related Activities

List relevant experiences/skills you believe support your job-related abilities - academic awards, professional memberships, offices held, etc. By law, you are
NOT REQUIRED to list any information indicating race, religion, sex, or national origin.
List relevant production/factory equipment you have operated
List relevant computer skills

Authorization Acknowledgement

1. Have you ever been convicted of, plead no contest (nolo contendere) to, or been fined in connection with any felony, misdemeanor, municipal ordinance violation, or any other type of offense (other than a parking ticket), regardless of the nature of the penalty or fine for that offense?

Yes / No / If yes, explain:

(If you are in doubt about the nature of any offense, please list; this question is designed to require disclosure of all past convictions, violations, fines or offenses, and the failure to list a conviction, offense, violation or fine will be considered falsification and will be grounds for refusal to hire or termination of employment. However, no applicant will be denied a position because of a past conviction, offense, violation or fine, which is not substantially related to the circumstances of the employment sought.)

2. Are you currently subject to a pending criminal charge for any misdemeanor or felony?

Yes / No / If yes, explain:

(This question is designed to elicit information on all pending criminal charges, whether felony or misdemeanor. However, no applicant will be denied a position because of a pending criminal charge which is not substantially related to the circumstances of the employment sought.)

I understand any offer of employment is contingent upon the successful completion of a pre-placement health assessment and pre-placement drug test unless prohibited by compliance with the Immigration Reform and Control Act. Any offer of employment is also considered at-will, meaning Expera may terminate an employment relationship at any time with/without cause, and an offer letter does not constitute an employment contract. I hereby give the Company the right to make a thorough investigation of my past employment and employment-related activities, and I release from all liability all persons, companies, and corporations supplying such information. I understand any false statement made by me in this application or other required documents shall be considered sufficient cause for denial of employment or discharge.I understand this application will remain active for no longer than 60 days from the date it was made.

Applicant Signature / Date