Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.(Divisions: Epcor Foundries / HiTech Shapes & Designs / A-G Tool & Die Co. / Hamilton Precision LLC) Seilkop Industries, inc. is an equal Employment Opportunity Employer. Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, disability or handicap, or any other legally protected status. All qualified applicants will be given equal opportunity and selection decisions are based solely on job-related factors. . Division: *Epcor FoundryHItech Shapes and DesignsA-G Tool & DieHamilton Precision, LLCPersonal InformationFull NameDate Available to StartAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutHome Phone *Cell Phone *Email *LayoutHave you ever filed an application with us before?YesNoIf Yes, give dateLayout (copy)Have you previously been employed by our company?YesNoIf Yes, give dateLayout (copy) (copy)Do you have any friends or relatives working hereYesNoIf so, please listLayoutAre you legally authorized to work in the United States?YesNoAre you at least 18 years of age?YesNoCan you provide proof of eligibility to work in the US?YesNo(Proof of eligibility will be required before you can be employed)Can you furnish a work permit?YesNoNot ApplicableLayoutPosition applied for:Are you willing to work:Full-timePart-timeTemporary2nd ShiftWeekendsOvertimeDesired Wages/Salary:Referral Source:EmployeeRelativeWalk-InAdvertisementOtherName of Source (if applicable)EducationElementary SchoolLayoutCityGrade Completed:12345678StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingHigh SchoolLayoutCityGrade Completed:9101112GED? YesNoNot ApplicableStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDid you graduate?YesNoCollegeLayoutCityDegree Received Or Expected:Course major/Field:StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAverage Grade:OtherLayoutCityDegree Received Or Expected:Course major/Field:StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAverage Grade:Other job-related, educational institutions, licenses, certifications, any specialized training, apprenticeship, skills or any additional information you feel may be helpful to us in considering your application.Do you have a reliable means of transportation to and from work?YesNoEMPLOYMENT HISTORY (List below last employers, starting with the most recent one first)LayoutPresent or last Position:From:Street Address:State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDuties:Starting Annual Salary:Bonus:Name of Supervisor:Phone Number of Supervisor:Name of Company:To:City:Zip:Reason for Leaving:Final Annual Salary:Commission:Title and Department of Supervisor:If currently employed, may we contact your supervisor?YesNoLayoutNext Previous Position:From:Street Address:State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDuties:Starting Annual Salary:Bonus:Name of Supervisor:Phone Number of Supervisor:Name of Company:To:City:Zip:Reason for Leaving:Final Annual Salary:Commission:Title and Department of Supervisor:Layout (copy)Next Previous Position: From:Street Address:State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDuties:Starting Annual Salary:Bonus:Name of Supervisor:Phone Number of Supervisor:Name of Company:To:City:Zip:Reason for Leaving:Final Annual Salary:Commission:Title and Department of Supervisor:REFERENCESList at least three responsible adults who have knowledge of your work ethic, experience, and ability. (Do not include relatives) LayoutName:Telephone No: *Address:Occupation:LayoutName:Telephone No: *Address:Occupation:LayoutName:Telephone No: *Address:Occupation:Additional Space (if needed):LayoutAre you currently on lay-off and subject to recall?YesNoHave you ever been bonded?YesNoIf so, has bond ever been refused or cancelled?YesNoHave you ever been convicted of a crime? (Sealed, expunged, pardoned, annulled and discharged convictions, juvenile convictions need not be disclosed. Also do not disclose or provide information concerning minor misdemeanor convictions for marijuana possession involving an amount less than 100 grams.)YesNoIf you answered “Yes” above, please provide information on the date, nature and circumstances of the conviction:Criminal convictions are not an absolute bar to consideration for employment. Factors such as age at time of conviction, length of time since offense, seriousness of offense, applicability of offense to position applied for, etc. will be consideredLayoutAre you bound by any non-compete agreements with your current or former employer(s):YesNoDo you have any commitments or other agreements with another employer that might affect your employment with (Company)?YesNoIf yes, attach a copy of agreement. Click or drag a file to this area to upload. If yes, please explain:LayoutIf applying for a position that requires driving, do you have a valid driver's license?YesNoHas your driver’s license been revoked, suspended, or limited during the past five years?YesNoIf “Yes” please explain below:LayoutDriver's license #Class:State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCDL:YesNoPlease describe any experience or special training received in the military or in government service related to the position for which you are applying:If applying for a clerical position, what business equipment can you operate? (For example, computers, copiers, etc.)If applying for a clerical/administrative/professional position that requires speed and accuracy on the keyboard, Layoutindicate your speed:Words/Minute:List the specific skills, qualifications you possess related to the position for which you are applying:In what computer software programs are you proficient? [Name the package(s).]PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING JOB APPLICANT'S AGREEMENT AND CERTIFICATION In consideration of my employment, I agree to conform to the policies and procedures of Seilkop Industries, Inc., including without limitation any of its affiliated companies and divisions (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 reason, and with or without notice at any time. I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any misrepresentation or falsification of information or significant omissions on either this application or during the pre-employment process will result in my application being rejected, or, may be cause for subsequent dismissal if I am hired. I also understand that any offer of employment may be conditioned on pre-employment procedures, which includes a background check, tests and documentation. I will, upon request, sign all necessary consent and authorization and release forms. I voluntarily and knowingly authorize the Company and/or its agents, to verify any aspect of the information contained in my employment application or through public and private sources. I authorize any third party organization to perform a consumer report and background investigation. I also authorize and consent any companies, schools or persons listed on this application (or accompanying resume) to give any information regarding my employment, qualifications and character to Seilkop Industries. I understand that the employment information may include, but is not necessarily limited to, performance evaluation and reports, job descriptions, disciplinary reports, letters of reprimand, and opinions regarding my suitability for employment possessed by it. I voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless you, your agents and any former employer, person, firm, corporation, school or government agency, its officers, employees and agents from any and all claims, liability, demands, causes of action, damages, or costs, including attorney's fees, present or future, whether known or unknown, anticipated or unanticipated, arising from or incident to the disclosure or release of any such information to you, your agents, or consumer reporting agency I understand that I may be required to take a drug test as a condition of employment or during employment. I may also be required to take and pass a physical exam if I am selected for employment and before beginning employment. I agree that in exchange for the Company considering my application for employment, and in exchange for any offer of employment that the Company may extend to me, to the maximum extent permitted by applicable law, I shall file any lawsuit (and all claims that could be included in that lawsuit) against the Company or any of its current or former owners, directors, managers, agents or other employees, relating to my application for employment, employment, or separation of employment, within 180 days after the date of the action or event that is the subject of my lawsuit. I hereby waive any statute of limitations to the contrary. I understand and agree that despite this 180 day statute of limitations, I can still file a charge with or participate, testify, or assist in any investigation or proceeding before any federal, state, or local government agency. To the extent I file a charge(s) with any federal, state, or local government agency, I agree that I am required to file the charge(s) within the statutory statute of limitations applicable to such charge(s). I have read and understand the contents of this employment application and am fully able and competent to complete it. LayoutDate *Signature: *WE ARE AN EQUAL OPPORTUNITY EMPLOYER NOTICE All offers of employment are conditional upon our assessment of the individual's ability to perform the essential elements of the job safely and efficiently. Following an offer of employment, our Company may provide a post-offer physical examination to assist in this assessment. The examination is conducted by a licensed physician specializing in such examinations. The cost of the physical is borne solely by our Company. Included in the examination is a hearing test, vision test, a comprehensive medical and occupational history questionnaire, vital signs, height, weight, a general physical examination, and a urine drug screen. Additionally, if you are offered a position that requires the ability to lift, you may be administered relevant tests. Results of the physical will be submitted under confidential cover to the Company's Human Resources Department. Where test results indicate the presence of illicit drugs and/or undeclared pharmaceutical and/or alcoholic substances, the offer of employment will be rescinded. Where test results make questionable your ability to perform the essential elements of the position in a safe and efficient manner, a meeting will be held with you to determine if reasonable accommodations can be made. By affixing your signature below, you certify that you have been advised via this notice of the tests which may be conducted, that you voluntarily agree to submit to such testing following an offer of employment, that you will authorize release of test results to the responsible agent of our Company, and that you understand and agree to all conditions stated above. Applicant's Signature: * Print name as signed above: *Date *Submit Specialists in Foundry Tooling from Design, Simulation, Pattern Building, Molds, and Core Boxes. Seilkop Divisions Seilkop Industries HiTech Shapes & Designs Epcor Foundry A-G Tool & Die Hamilton Precision Contact Us 425 North Bend Road Cincinnati, Ohio 45216 513-633-9274 [email protected]