Back
Astro Shapes LLC
Application for Employment
An equal opportunity employer
Equal access to programs, services and employment opportunities is available to all persons without regard to sex (including pregnancy), race, color, religion, national origin, citizenship, age, disability, genetic information, or any other basis protected by federal, state, and/or local law.

In accordance with the Americans with Disabilities Act and/or applicable state and local laws, applicants requiring reasonable accommodations for the application and/or interview process should notify the Human Resources Department. Examples of reasonable accomodation include making a change to the application process; providing written materials in an alternate format such as braille, large print or audio recording; using a sign language interpreter; using specialized equipment; or modifying testing conditions.

Required Field
Applicant Information
Application Date
First Name
Middle Name
Last Name
Applicant ID #
Address
City
State
Zipcode
Contact Information
Primary Phone #
Other Phone #
E-Mail Address
If necessary, best time to call you is:
May we contact you at work?
If yes, please provide your work phone # and best time to call:
Employment Information
Position(s) applied for
Referral Source (e.g., Walk-in, Job Posting, Company's Website, etc.)
If you are under 18 and it is required, can you furnish a work permit?
If no, please explain:
Have you submitted an application here before?
If yes, give date(s) and position(s)
Have you ever been employed here before?
If yes, give date(s):
From To
Is this application a request for reemployment following an extended military leave of absence from this company? If yes, additional information may be requested.
Are you lawfully authorized to work in the United States?
Date available for work:
What is your desired salary range or hourly rate of pay?
$ Per
Type of employment desired:
Will you relocate if job requires it?
Will you travel if job requires it?
If they have been explained to you, are you able to meet the attendance requirements of the position?
Will you work overtime if required?
If no, please explain:
Employment Information (continued)
Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accomodation)?
This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existance of a disability, particular accomodation or whether accomodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.


Driver's license number required if driving may be required in the job for which you are applying:
State
Have you ever been bonded?
Have you entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company?
If yes, please explain:
Employment History
Explain any gaps in your employment, other than those due to personal illness, injury or disability.
If not addressed on the previous page, have you ever been fired or asked to resign from a job?
If yes, please explain:
Previous Employer #1
Starting with your most recent employer, provide the following information. You may include any verified work performed on a volunteer basis.
Employer
Telephone #
Address
City
State
Starting Job Title
Final Job Title
Dates Employed
From To
Immediate supervisor and title (for most recent position held)
May we contact for reference?
Supervisor's E-Mail
Why did you leave?
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about the position?
Previous Employer #2
Starting with your most recent employer, provide the following information. You may include any verified work performed on a volunteer basis.
Employer
Telephone #
Address
City
State
Starting Job Title
Final Job Title
Dates Employed
From To
Immediate supervisor and title (for most recent position held)
May we contact for reference?
Supervisor's E-Mail
Why did you leave?
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about the position?
Previous Employer #3
Starting with your most recent employer, provide the following information. You may include any verified work performed on a volunteer basis.
Employer
Telephone #
Address
City
State
Starting Job Title
Final Job Title
Dates Employed
From To
Immediate supervisor and title (for most recent position held)
May we contact for reference?
Supervisor's E-Mail
Why did you leave?
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about the position?
Previous Employer #4
Starting with your most recent employer, provide the following information. You may include any verified work performed on a volunteer basis.
Employer
Telephone #
Address
City
State
Starting Job Title
Final Job Title
Dates Employed
From To
Immediate supervisor and title (for most recent position held)
May we contact for reference?
Supervisor's E-Mail
Why did you leave?
Summarize the type of work performed and job responsibilities.
What did you like most about your position?
What were the things you liked least about the position?
Skills and Qualifications
Summarize any special training, skills, languages, licenses, and/or certificates that may assist you in performing the position for which you are applying:
Computer Skills
Include software titles and level of experience.
Word Processing
Spreadsheet
Presentation
E-Mail
Internet
Other 1
Other 2
Other 3
Educational Background
Starting with your most recent school attended, provide the following information.
School #1
School (include city and state)
Number of years completed
Completed
GPA/Class Rank
Major/Minor/Certification
School #2
School (include city and state)
Number of years completed
Completed
GPA/Class Rank
Major/Minor/Certification
School #3
School (include city and state)
Number of years completed
Completed
GPA/Class Rank
Major/Minor/Certification
School #4
School (include city and state)
Number of years completed
Completed
GPA/Class Rank
Major/Minor/Certification
References
List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Reference #1
Name
Title
Relationship to You
Telephone
E-Mail
# of Years Known
Reference #2
Name
Title
Relationship to You
Telephone
E-Mail
# of Years Known
Reference #3
Name
Title
Relationship to You
Telephone
E-Mail
# of Years Known
Related Information
When answering these questions, please exclude any information that would reveal sex (including pregnancy), race, color, religion, national origin, citizenship, age, disability, genetic information, or other similarly protected status.
To what job-related organizations (professional, trade, etc.) do you belong?
List special accomplishments, publications, awards, etc.
List any relevant volunteer work.
Is there any other job-related information you want us to know about you?
Application Statement
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct.

I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, 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 representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state, or federal law.

I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or finite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contract to the foregoing express language are valid unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.

I understand that reasonable safeguards will be taken to protect all personal information provided or obtained in conjunction with this application for employment. My personal information may be shared with the employer's affiliate(s) and third parties engaged by the employer to perform services for the employer. Any personal information shared with an affiliate or third party is to be used solely to perform the services requested by the employer.

This company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex (including pregnancy), race, color, religion, national origin, citizenship, age, disability, genetic inforamtion, or any other protected status under applicable federal, state, or local law.

Mandatory Employer Disclosures
Notice to Maryland applicants: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
Notice to Massachusetts applicants: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities.
Notice to Rhode Island applicants: This company complies with Rhose Island law prohibiting smoking in enclosed areas within places of employment.
Notice to North Dakota applicants: This compant complies with North Dakota law prohibiting smoking within 20 feet of entrance and inside places of employment.
Notice to Indiana applicants: This company complies with Indiana law prohibiting smoking in enclosed areas within places of employment.
Notice to Illinois applicants: Please be advised pursuant to Illinois law, applicants are not obliged to disclose expunged juvenile records of adjudication, arrest or conviction.

I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICATION STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement
Type name below
Date