Employment Application

Personal Information

Last Name *

First Name *

Middle Name *

Street Address *

City *

State *

Zip *

Phone Number *

Email Address *

Referred By *

Employment Desired

Position Apply For *

Date You Can Start *

Expected Pay *

Are you employed now? *

Yes
No

Have you ever been employed here before? *

Yes
No

Have you filled an application here before? *

Yes
No

Are you at least 18 years of age or older? *

Yes
No

Are you legally eligible for employment in the United States? *

Yes
No

Education

High School *

Course of Study *

Years Completed *

Did You Graduate *

Yes
No

Tech School/College/Other *

Course Of Study *

Years Completed *

Did you Graduate *

Yes
No

Other

Course Of Study

Years Completed

Did you Graduate

Yes
No

Military

Branch of Service

Duties

Prior Employment

First Employer *

Address *

Supervisor's Name *

Employer Phone *

Position *

Reason For Leaving *

Start Date - End Date *

Duties *

Second Employer

Address

Supervisor's Name

Employer Phone

Position

Reason For Leaving

Start Date - End Date

Duties

Third Employer

Address

Supervisor's Name

Employer Phone

Position

Reason For Leaving

Start Date - End Date

Duties

Fourth Employer

Address

Supervisor's Name

Employer Phone

Position

Reason For Leaving

Start Date - End Date

Duties

References

Give below the Names of Three Persons Not Related To You, Whom You Have Known At Least One Year.

Name *

Name

Address *

Address

Business *

Business

Telephone *

Telephone

Years Acquainted *

Years Acquainted

Consent

I expressly authorize without reservation the employer, its representatives, employees or agents to contact and obtain information from all references, personal and professional, employees, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job Interview. I hereby waive any and all rights and claims I may have regarding the employer, Its agents, employees or representitives for seeking, gathering and using truthful and non-deflamatory information in a lawful manner in the employment process and all other persons, companies or organizations for furnishing such information about me. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree" that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.

I authorize any physician or hospital to release any Information which may be necessary to determine my ability to perform the duties or a job I am being considered for prior to employment or in the future during my employment with GPK. I consent to take a medical examination by a qualified physician at the discretion of my employer.

I further understand that this is an application for employment and that no employment contract is being offered.

Although management makes every effort to accommodate individual preferences, business needs may at time make the following conditions mandatory; overtime, shi work, a rotating work schedule, or a work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment.

I have read and understand the above.

Today's Date *

Signature *

GPK Products Inc. has, since 1971, built our reputation of superior customer service through engineering and product excellence. We have developed over 4100 molded and fabricated fittings, cataloged in sizes through 54" for nearly every field application.

800.437.4670

info@gpk-fargo.com

1601 43rd St. N. North Dakota 58102

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