DSM employment application

First:
Middle:
Last:

Street:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginina Washington West Virginia Wisconsin Wyoming Outside of USA
Zip:
Phone:
Fax:
E-mail:
Notify by:	Fax E-mail Mail Telephone

1.	Which Department would you prefer?	Any available Accounting Band Saw / Chop Saw CNC Programming Customer Service Deburr Drill Press Engineering Forming Grinding Hardware Human Resources Inspection Laser Lathe Milling Office Clerical Punching Quality Control Sales Shearing Shipping Welding
2.	Which shift would you prefer?	Any available DAY SHIFT (STARTS 7:00 AM) NIGHT SHIFT (STARTS 3:30 PM)
3.	Are you willing to work overtime?	Yes No
	IF NO, PLEASE EXPLAIN
4.	When would you be able to start employment with DSM?

1.	Are you legally eligible for employment in the U.S.A.? (If yes, verification will be required.)	Yes No
2.	Are you of legal age (at least 18) to be employed? (If yes, verification will be required.)	Yes No
3.	Will you be able to present your original Social Security Card when required?	Yes No
4.	Have you been employed by DSM before?	Yes No
	If yes, explain:
5.	Do you have reliable transportation to and from work?	Yes No
6.	DSM expects perfect attendance during the first 3 months of employment. Can you meet this standard?	Yes No
7.	Have you had First Aid training?	Yes No
	If yes, what and when?
8.	What is the highest level of education that you completed?	10 11 12 13 14 15 16 17 18+
9.	Diplomas, licenses, training certificates: Replace this message with your high school, GED Certificates, Awards, etc.
10.	What experience, skills, hobbies or other qualifications do you have? (THE APPLICANT SHOULD NOT LIST ANY INFORMATION INDICATING RACE, CREED, COLOR, GENDER, AGE, DISABILITY, NATIONAL ORIGIN, OR OTHER PROTECTED GROUP.) Replace this message with your experience, skills, hobbies, or other qualifications.

You may list personal references. This is optional: Replace this message with information about your personal references. Include their relationship to you, their phone number, and how long you have known them. Remember, this is optional.

List present and past employment, beginning with your most recent:

Employer:
Telephone:
Supervisor:
Position held:
Dates employment started: ended:
Wages per hour per week per month annual salary started: $ ended: $
Reason for leaving:
May we contact this employer? Yes No
Employer:
Telephone:
Supervisor:
Position held:
Dates employment started: ended:
Wages per hour per week per month annual salary started: $ ended: $
Reason for leaving:
May we contact this employer? Yes No
Employer:
Telephone:
Supervisor:
Position held:
Dates employment started: ended:
Wages per hour per week per month annual salary started: $ ended: $
Reason for leaving:
May we contact this employer? Yes No

• I understand that either I or the Company may terminate my employment at any time for any reason.
• I understand that this application is not a contract of employment and does not obligate the employer to provide any benefit.
• I understand that the granting of interviews does not obligate the employer to provide any benefit or guarantee.
• I authorize the company to investigate thoroughly my work and personal history and verify all data given. In return for being considered for employment, I release the company from any liability which might arise from such an investigation.
• I authorize all individuals, schools, and firms named on this application, except my present employer if so noted, to provide any information requested about me, and I release them from any liability for damage in providing this information.
• I understand that any falsification or willful omission may result in dismissal or refusal of employment.

Replace this with additional reasons why you can help DSM succeed.