Application for Employment

NOTE: This application form was designed for use by persons applying for various types of positions. Some questions may not be completely applicable to your situation, but we ask that you answer all job-related inquires to the best of your ability.

Grand River Rubber is an Equal Opportunity Employer. All candidates will be evaluated on the basis of their qualifications for the job in question. Federal and/or state law prohibits discrimination on the basis of race, color, religion, sex, national origin, age, disability, or any other protected status. Please advise us if any accommodations are required to assist you in the application process.

Name*
First Middle Last
Address*
Street Address City State ZIP Code
Home Phone*
Work Phone
Mobile Phone
Preferred Phone*
- Home
- Work
- Mobile
Email*
Position Desired
Employment Status*
- Full-time
- Part-time
- Other
Date Available*
MM slash DD slash YYYY
Salary / Compensation Desired
Referral Source*
- Employment Agency
- Newspaper Ad
- Walk-in Applicant
- School/College
- Employee Referral
- Other
Other Referral Source
Have you ever applied for a position with us?*
- Yes
- No
When?*
Have you ever been employed by us?*
- Yes
- No
When?*
Do you have any relatives or close friends working here?*
- Yes
- No
State and identify relationship*
Educational Data
High School
High School Name
High School Address
Street Address City State ZIP Code
Years Completed
GED/Diploma
College
College Name
College Address
Street Address City State ZIP Code
Years Completed
Degree
Graduate School
Graduate School Name
Graduate School Address
Street Address City State ZIP Code
Years Completed
Degree
Trade, Business, Night, or Correspondence School
School Name
Address
Street Address Address Line 2 City State ZIP Code
Years Completed
Degree
Major Course of Study
Other Education
School Name
School Address
Street Address Address Line 2 City State ZIP Code
Years Completed
Degree
Major Course of Study
Employment History

In the following spaces, give a complete record of your employment including periods of unemployment, if any. Begin with your most recent employment and work back.

If additional space is needed, attach a supplementary sheet or provide details via email.

Employer 1
Company
Address
Street Address Address Line 2 City State ZIP Code
Phone
Starting Position
Last Position
Final Salary
Duties
Reason for Leaving
Employed From
Employed To
Employer 2
Company
Address
Street Address Address Line 2 City State ZIP Code
Phone
Starting Position
Last Position
Final Salary
Duties
Reason for Leaving
Employed From
Employed To
Employer 3
Company
Address
Street Address Address Line 2 City State ZIP Code
Phone
Starting Position
Last Position
Final Salary
Duties
Reason for Leaving
Employed From
Employed To
Additional Inquiries Concerning Employment History
May we contact your present employer?
- Yes
- No
May we contact your previous employer(s)?
- Yes
- No
Please identify any exceptions and reasons for not contacting.
Have you ever been dismissed or forced to resign from any employment?*
- Yes
- No
Please Explain
Except for vacation and holidays, from how many work days were you absent during the past calendar year?
Military Experience
Have you ever served in the U.S. Armed Forces?*
- Yes
- No
Dates Served*
Describe any special job-related training received.
Relevant Skills
List skills relevant to the position for which you're applying.
General Information
Are you under 18 years of age?*
- Yes
- No
Under 21?*
- Yes
- No
Have you ever been convicted of a felony?*
(An affirmative response will not automatically disqualify you from being considered as a candidate for employment.)
- Yes
- No
Please Explain*
Evening or weekend work my be required. Can you fulfill such scheduling requirements?*
- Yes
- No
Are you willing to work overtime as requested?*
- Yes
- No
PPE (Personal Protection Equipment)

Your employment with Grand River will require you to wear designated PPE that could include: Safety Glasses, Dust Mask, Cotton Gloves, Ear Plugs, Welding Shield, Non-conductive Shoes, Rubber or Butyl Gloves, 2 Gloves per hand.
Are you capable of this without restriction?
- Yes
- No
Resume
If you would like to attach a resume or other related document, click on Choose File. If you have trouble sending the document with this form, you can also email it directly to kwyatt@grrp.com.
Max. file size: 100 MB.
Applicant's Statement

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that any falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at any later date.

I authorize a thorough investigation of my past employment and activities, agree to cooperate in such investigation, and release from all liability or responsibility all persons and corporations requesting or supplying such information.

Any time after a conditional offer of employment or during employment, if hired, I authorize any physician or health care provider to release information advising Grand River Rubber & Plastics: (1) whether I am currently able to perform the specific job for which I am being considered or employed with or without reasonable accommodation and the basis for such conclusions; and (2) whether I can perform the job without posing a direct threat to the health or safety of myself or others.

I hereby agree to submit to any lawful drug, polygraph or integrity testing that may be required as a condition of employment or continued employment and understand that refusal to submit to such testing during the course of my employment may result in disciplinary action, up to and including discharge.

I understand that my employment is terminable-at-will, that I am not being employed for any specific time, and that this application is not intended to be a contract for continued employment. I further understand that no officer, employee, or agent has the authority to change the at-will nature of the employment relationship except by a fully executed written contract of employment for a specific term.

I understand that according to federal law all individuals who are hired must, as a condition of employment, produce certain documentation to verify their identify and U.S. citizen status, or, if aliens, their legal authorization to work in the U.S. As a consequence, I understand that any offer of employment would be contingent on my ability to produce the required documentation within the time period required by law.
Agreement*
- I have read and agree to the above Applicant's Statement.

Application for Employment

Educational Data

High School

College

Graduate School

Trade, Business, Night, or Correspondence School

Other Education

Employment History

Employer 1

Employer 2

Employer 3

Additional Inquiries Concerning Employment History

Military Experience

Relevant Skills

General Information

PPE (Personal Protection Equipment)

Applicant's Statement

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