Step 1 of 4 25% PERSONAL INFORMATION An * signifies a required field.Name:* First Middle Last Date of Birth* MM slash DD slash YYYY Date: MM slash DD slash YYYY Address:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Are you 18 years or older? Yes No Are you legally eligible to work in the United States? Yes No EMPLOYMENT DESIREDPosition: Salary Desired: Date Available: MM slash DD slash YYYY Ever applied to this company before? Yes No How did you learn about us?Do you have friends or relatives employed here?* Yes No Please list them: Are you physically and mentally capable of performing the work applied with or without reasonable accommodation?* Yes No 1[1] The Age Discrimination Act of 1987 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age. EDUCATION AND SKILLS HIGH SCHOOLName and location of school: Did you graduate? Yes No TECHNICAL SCHOOL/COLLEGEName and location of school: Did you graduate? Yes No List your skills and qualifications which apply to this position (I.E. welding, grinding, forklift, etc.): Work Experience (List below your last three employers, starting with the last)Employer date from (Job #1): MM slash DD slash YYYY Employer date to (Job #1): MM slash DD slash YYYY Name and address of employer (Job #1): Position/job (Job #1): Salary/wage (Job #1): Reason for leaving (Job #1)Employer date from (Job #2) MM slash DD slash YYYY Employer date to (Job #2): MM slash DD slash YYYY Name and address of employer (Job #2): Position/job (Job #2): Salary/wage (Job #2): Reason for leaving (Job #2)Employer date from (Job #3) MM slash DD slash YYYY Employer date to (Job #3): MM slash DD slash YYYY Name and address of employer (Job #3): Position/job (Job #3): Salary/wage (Job #3): Reason for leaving (Job #3)Which of these jobs did you like best and why?Please read before signing: I certify that the facts contained in this application, resume, and attachments are true and complete to the best of my knowledge and understand that, if employed, falsified statements may result in termination. I understand that if I receive a conditional job offer, I may be requested to take an employment examination before starting to work. In the event that I have a disability that will affect my ability to take that test(s), I will so inform the Company prior to the administration of the test so that reasonable accommodation can be made. The Company reserves the right to require medical documentation regarding the need for accommodation. I understand that if the Company employs me, my employment is AT-WILL. THIS MEANS THAT IF I AM HIRED, EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME WITH OR WITHOUT CAUSE AND FOR ANY OR NO REASON. I authorize an investigation of all statements contained in this application, resume and attachments for any employment-related purpose. I authorize all of my previous employers to provide you with any and all applicable information they may have. This investigation, if made, may also include information about any and all employment discrimination claims and/or accusations brought against me relating to harassment and/or discrimination involving race, religion, sex, age, disability or national origin. l hereby release these references and previous employers from all liability for any information they may provide. I understand that no official of the Company, other than the President, has any authority to enter into an agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.Today's Date MM slash DD slash YYYY Signature* (Typing in your name will serve as your signature) SELF-IDENTIFICATION Bulldog Battery Corporation is a government contractor subject to the provisions of Executive Order 11246, which requires the company to take affirmative action to employ qualified individuals. Completion of this form is voluntary. Your information will be kept confidential; it will not be filed with your application. Refusal to complete this form · will not deny you further consideration for employment.Name: First Last Date MM slash DD slash YYYY Position applying for: Race/Ethnicity: American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or Pacific Islander White Two or more races Gender: Male Female I certify that the information provided above is true and correct to the best of my knowledge. I understand that, if employed, falsified statements on this application for employment will be considered grounds for termination.* I authorize I authorize the company to thoroughly investigate my work experience and any other matters related to my suitability for employment. I further authorize my former employers to disclose to Bulldog Battery Corporation any and all information concerning my previous employment. In addition, I hereby release Bulldog Battery Corporation, my former employers (as listed above), and all other persons from any and all claims, demands, or liabilities arising out of, or in any way related to, such disclosure.* I authorize I acknowledge that, if employed, both the company and I have the right to terminate the employment relationship at any time, with or without cause or advance notice. This employment at will relationship will remain in effect throughout my employment with Bulldog Battery Corporation and may not be modified by any oral or implied agreement.* I authorize Note: This form is for use prior to the issuance of an offer of employment.CAPTCHA