Application for Employment

We appreciate your interest in Western Enterprises, a Scott Fetzer company. Western is an equal employment opportunity employer. The Company’s policy is not to discriminate against any applicant or employee based on race, color, sex, religion, national origin, age, disability, or any other basis protected by applicable federal, state, or local laws. Western also prohibits harassment of applicants or employees based on any of these protected categories. It is also Western’s policy to comply with all applicable state and federal laws respecting consideration of unemployment status in making hiring decisions.

"*" indicates required fields

GENERAL INFORMATION

Location*
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Name*
Address*
Have you ever used any other name(s) which is (are) necessary for us to know in order for us to verify your employment or educational record?*
Have you previously worked for or applied for a position with Western Enterprises or any other Scott Fetzer companies, in any of our locations either as an employee or through an employment agency?*
MM slash DD slash YYYY
Are you at least 18 years old?*
What employment status do you desire?*
Do you have any relatives now employed at Western Enterprises?*

PERMISSION TO WORK

Will you now or in the future require sponsorship for employment visa status (e.g. H-1B status)?*

REFERRAL INFORMATION

How did you learn about Western?*

WORK EXPERIENCE

Please specify your complete full-time and part-time employment history, including self-employment. You may include any verified work performed on a volunteer basis. Begin with your most recent employer.

JOB # ONE

Address*

Employed (Month and Year)

Monthly Wages

JOB # TWO

Address*

Employed (Month and Year)

Monthly Wages

JOB # THREE

Address*

Employed (Month and Year)

Monthly Wages

All employers including your current employer may be contacted to verify the information you provide. May we contact your current employer prior to any offer of employment?*

PROFESSIONAL REFERENCE

Individual not related to you. Business reference preferred.

Name*
Address*

EDUCATION & TRAINING

High School

Address

Business/Trade/Technical

Address

College

Address

Graduate School

Address

APPLICANT'S STATEMENT

I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered.*
I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice. I understand that only the Group President of Western, and no manager, supervisor, or other representative of the Company, has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will employment relationship, and with respect to any agreement entered into by the Group President, any such agreements must be in writing and signed by the Group President and by me or my authorized representative*
I further understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by Western Enterprises.*
I understand that if I am offered employment, I may be required to sign a non-solicitation and non-disclosure agreement, as a condition of the employment.*
I understand that the Company may share the information contained in this application with other Company employees for employment and administrative purposes and hereby consent to such transfer.*
I hereby authorize the Company to conduct any necessary investigation regarding my background as it relates to the position I am seeking and to the extent permitted by federal, state, and local law. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection with the provision and use of such information.*
I understand and expressly agree that if employed by the Company, storage areas provided for me (locker, desk, etc.) are open to investigation by the Company without prior notice to me*
I agree to undergo a pre-employment physical examination consistent with federal and state law.*
I agree to submit to legally permissible drug testing upon an offer of employment from Western and prior to starting work. I agree that any offer of employment is contingent upon my receiving a negative test result.*

THIS AGREEMENT IS A WAIVER OF ALL RIGHTS TO CIVIL COURT ACTIONS FOR A CLAIM SUBJECT TO ARBITRATION. ONLY THE ARBITRATOR, NOT A JUDGE OR JURY, WILL DECIDE THE CLAIM OR DISPUTE.

APPLICANT'S ACKNOWLEDGEMENT

My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between the Company and me concerning the topics addressed herein, and supersedes any prior inconsistent understandings between the Company and me on such issues.

MM slash DD slash YYYY

This application will only be considered for 30 days. If you have not been hired within 30 days of submitting this application and you wish to be considered for employment, you must complete another application.

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