Application – MBI JOBS

Name *

Home Phone *

Other/Mobile Phone

Address *

Apt, suite, etc.

Country

City

State

Zip code

Email *

Are you 18 years of age or older? * *

Yes

Are you legally entitled to work in the U.S? * *

Yes

Have you ever been convicted of a crime other than a minor traffic violation? * *

Yes

If you have been convicted of a crime other than a minor traffic violation, please describe fully the criminal conviction(s), listing the nature of the offense, the date and place of conviction(s), final disposition, dates of Incarceration if applicable,

How did you hear about the job opportunities at Mar-Bal?

If you were referred to Mar-Bal by a current employee, please enter their name here:

POSITION -

Position or Type of Employment Desired * *

Date you can start * *

Are you able to perform the following functions with or without reasonable accommodations?

Work Weekends * *

Yes

Work Overtime * *

Yes

Work With Fiberglass * *

Yes

Lift 50 pounds on a regular basis: * *

Yes

Lift 25 pounds on a regular basis: * *

Yes

Work Shifts -

1st Shift * *

Yes

2nd Shift * *

Yes

3rd Shift * *

Yes

Are you related to anyone who works for Mar-Bal, Inc? * *

Yes

If so please provide name(s) below.

Have you ever worked for this company before? * *

Yes

If so, when

Supervisor's Name

Reason for leaving:

- WORK EXPERIENCE -

Employer (Current) *

Phone *

From Date *

To Date *

Address *

Apt, suite, etc.

Country

City

State

Zip code

Job Title *

Number of Employees Supervised *

Hours Per Week *

Specific Duties *

Last Salary

Supervisor *

Reason for Leaving *

May We Contact This Employer? *

Yes

Next Most Recent Employer

Employer *

Phone *

From Date *

To Date *

Address *

Apt, suite, etc.

Country

City

State

Zip code

Job Title *

Number Of Employees Supervised *

Hours Per Week *

Specific Duties

Last Salary *

Supervisor *

Reason for Leaving *

May We Contact This Employer? *

Yes

Next Most Recent Employer

Employer

Phone

From Date

To Date

Address

Apt, suite, etc.

Country

City

State

Zip code

Job Title

Number Of Employees Supervised

Hours Per Week

Specific Duties

Last Salary

Supervisor

Reason for Leaving

May We Contact This Employer?

Yes

Next Most Recent Employer

Employer

Phone

From Date

To Date

Address

Apt, suite, etc.

Country

City

State

Zip code

Job Title

Number Of Employees Supervised

Hours Per Week

Specific Duties

Last Salary

Supervisor

Reason for Leaving

May We Contact This Employer?

Yes

Were there any periods of unemployment since high school?

Yes

If yes, list dates and reasons below:

Have you ever been discharged from any job or asked to resign?

Yes

If yes, please describe in detail, including the name of the employer, dates, and reasons for discharge or resignation:

Have you ever been disciplined for attendance?

Yes

Have you ever been disciplined for tardiness?

Yes

Do you have reliable transportation?

Yes

- Education and Training -

High School Graduate or General Education (GED) Test Passed?

Yes

If no, list the highest grade completed.

College, Business School, Military (Most recent first)

Name and Location

Attended From

Attended To

Credits Earned (Quarterly or Semester)

Credits Earned (Other)

Graduate

Yes

Degree & Year

Major or Subject

Name and Location

Attended From

Attended To

Credits Earned (Quarterly or Semester)

Credits Earned (Other)

Graduate

Yes

Degree & Year

Major or Subject

Name and Location

Attended From

Attended To

Credits Earned (Quarterly or Semester)

Credits Earned (Other)

Graduate

Yes

Degree & Year

Major or Subject

Name and Location

Attended From

Attended To

Credits Earned (Quarterly or Semester)

Credits Earned (Other)

Graduate

Yes

Degree & Year

Major or Subject

Occupational License, Certificate or Registration

Number

Where Issued

Expiration Date

Occupational License, Certificate or Registration

Number

Where Issued

Expiration Date

Occupational License, Certificate or Registration

Number

Where Issued

Expiration Date

Language Read, Written or Spoken Fluently Other Than English

Veteran Information (Most Recent)

Branch of Service

Date of Entry

Date of Discharge

Special Skills

- Applicant's Statement -

I certify that the information contained in this application is true and complete to the best of my knowledge.I understand that any false statements or omissions may result in Mar-Bal’s refusal to hire me or, if employed, false statements or omissions on this application are grounds for immediate dismissal upon discovery thereof. 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 liabillties for any damage that may result from furnishing the same to you. I understand that I may be required to undergo a medical examination and drug testing before beginning work and that any offer of employment may be withdrawn if I do not pass the medical examination or drug testing.

I agree that my employment may be terminated by Mar-Bal at any time without liability for wages or salary except such as may have been earned at the date of such termination. If requested by the management at any time, I agree to submit to search of my person or of any locker that may be assigned to me,and I hereby waive all claims for damages on account of such examination

In consideration of my employment, I agree to abide by Mar-Bal’s rules and regulations. I understand tha tmy employment and compensatlont can be terminated, with or without cause, and with or without notice, at any time,at the option of either the Company or myself. I understand that no manager or supervisor other than the owners of Mar-Bal have any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

I authorize investigation of all statements contained in the application for employment as may be necessary in arriving at an employment decision.