Orazen Extruded Polymers

999 S. Chillicothe Road

Aurora, Ohio

44266 330-577-8211 / www.orazen.com

We are an Equal Opportunity Employer and fully subscribe to the principles of Equal Employment Opportunity. Applicants and/or employees are considered for hire, promotion and job status, without regard to race, color, religion, creed, sex, marital status, national origin, age, physical or mental disability.

Full Name

Date of Application

Address

Home Address

City

State

Country

Postal Code

Phone *

Email *

1. General Information

Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation?

Yes

No

Have you been convicted of any felonies other than minor traffic violations during the past seven years? (A criminal record or a conviction will not automatically bar employment but will be considered only as it reasonably relates to your fitness to perform in the position for which you are applying.)

Yes

No

If yes, explain

2. Education & Training

Select last grade completed

Name of Last School

List any scholarships, academic honors, awards or special achievements:

3. Skills

Please list any skills you have that are appropriate for the position you are applying for:

If required, will you work?

Rotating shifts

Overtime

Saturdays

Sundays

Position applying for, be specific:

Salary Requirements:

State fully why you believe you are qualified for this position:

INTERESTS / ACCOMPLISHMENTS: You may wish to list significant experience, interests & accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the position (s) you are seeking. Names or organizations designating religion, race, etc. need not be mentioned.

Date you can start:

4. Employment History

Starting with your PRESENT or MOST RECENT EMPLOYER list in consecutive order ALL EMPLOYMENT for at least the past THREE employers. If currently employed, may we contact your employer?

Yes

No

PRESENT OR MOST RECENT EMPLOYER

FULL NAME OF COMPANY

STREET ADDRESS

CITY

STATE

ZIP

NAME & TITLE OF SUPERVISOR

TITLE OF YOUR POSITION

SALARY

DATES EMPLOYED

REASON FOR LEAVING:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:

PRESENT OR MOST RECENT EMPLOYER (2)

FULL NAME OF COMPANY

STREET ADDRESS

CITY

STATE

ZIP

NAME & TITLE OF SUPERVISOR

TITLE OF YOUR POSITION

SALARY

DATES EMPLOYED

REASON FOR LEAVING:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:

PRESENT OR MOST RECENT EMPLOYER (3)

FULL NAME OF COMPANY

STREET ADDRESS

CITY

STATE

ZIP

NAME & TITLE OF SUPERVISOR

TITLE OF YOUR POSITION

SALARY

DATES EMPLOYED

REASON FOR LEAVING:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:

READ CAREFULLY: I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission of information may result in denial of employment or discharge. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

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