Position applying for:

Last Name:

First Name:

MI:

Street Address:

City:

State:

Zip:

Phone:

Email:

Work Availability:Full TimePart TimeWeekends

Check all that apply:Day ShiftNight ShiftOvertime & Holiday

Have you ever been employed by Great Lakes Polymer Technologies or subsidiary (Fabpro or Bridon) in the past?YesNo
If yes, when and where:

Date available to work (dd/mm/yyyy):

Relatives or friends working here:

Upon employment, will you be able to submit verification of your identity and your right to work in the U.S.?YesNo

Salary Expectations:

Are you employed now?YesNo

May we contact your present employer:YesNo

High School:

YesNo

Trade School / Technical College / Community College:

YesNo

College / University:

YesNo

Training Programs or Certifications:

Have you ever been convicted of a crime or a lawful offense other than a minor traffic violation?YesNo
If yes, please explain:

Veteran of the U.S. military service?YesNo
Years served:

Company Name:

Address:

Position title(s):

Description of duties:

Phone:

Dates:

Salary:

Supervisor:

Company Name:

Address:

Position title(s):

Description of duties:

Phone:

Dates:

Salary:

Supervisor:

Company Name:

Address:

Position title(s):

Description of duties:

Phone:

Dates:

Salary:

Supervisor:

Where you referred by an employee?YesNo

Employee name: