5070 E N AVE
KALAMAZOO MI 49048-9785
Application for Employment
Location:

E-Mail Address:

Form: App-01
Rev F

IMPORTANT:
Humphrey Products is an equal opportunity employer. All candidates for employment will be evaluated on the basis of their qualifications for the job for which the application is submitted. Federal and/or state law prohibits discrimination on the basis of race, color, religion, sex, national origin, age, disability, height, weight, and other protected classifications.
Thank you for your interest in a career with Humphrey Products.

Before you begin, please be advised that you will need approximately 1 hour to complete the entire application process. Please note if you choose to log out of this session before completing each step your information will be lost and you will not be considered for employment.

You must complete all sections to be considered for employment

1) Application (including salary history)
2) Upload Resume
3) Background Authorization
4) Skills Assessment
5) PI Survey

Only top candidates will be chosen for interviews (either by phone or face-to-face). We may also contact you for further information. Once again, thank you for choosing Humphrey Products as a career choice.
You may now begin the process below.
PERSONAL
First Name
Middle Name
Last Name
Present Address (Number & Street)
Do you have your own transportation?
(City, State, Zip Code)
Do you meet the education requirements of an HSD or GED?
Phone No. (Include Area Code)
Social Security No.
xxx-xx-
Date you can start employment
Wage Expectations
Are you a U.S. Citizen?
Do you have current unrestricted work authorization in the USA?
Will you need employment immigration sponsorship?
Are you presently 18 years of age or older?
Availability for Work
Do you have a valid driver's license?
If yes, specify state and license no.
Are you willing to travel?
Are you acquainted with any employees of Humphrey Products?
If yes, give names and locations.
Have you ever been employed by Humphrey Products?
If yes, specify position(s) and dates of employment.
Are you willing to relocate?
List Geographical Preferences.
List Geographical Exclusions.
Have you ever been convicted of a Felony?
Offense
Date
Location
If yes, please explain.
MEDICAL HISTORY
Are you able to perform the duties of the job for which you have applied?
What accomodation(s) could be made to allow you to perform the essential functions of this job as expected by Humphrey Products?
U.S. MILITARY RECORD
Service Branch
Are you a member of the Active Reserves or National Guard?
Service Dates
Entered Discharged
Initial Rank
Final Rank
Briefly describe your military duties.
Specifiy any commendations or recognition.
List any special training or skills received.
EDUCATION AND TRAINING

Type of School


Name, City, State

Major or Study

Degrees

High School





College/University





Graduate School





Trade of Business School




Describe any other relevant training or reference.
WORK EXPERIENCE
STARTING WITH CURRENT/MOST RECENT POSITION
Please provide complete full-time and part-time employment record
(Please do not state "see resume")
Employer (1)
Employment Dates
From To
Wages
Start End
Street Address
Position Title and Duties
City and State
Phone Number
Reason for Leaving
Name and Title of Immediate Supervisor
Summarize the nature of work performed and job responsibilities.
Employer (2)
Employment Dates
From To
Wages
Start End
Street Address
Position Title and Duties
City and State
Phone Number
Reason for Leaving
Name and Title of Immediate Supervisor
Summarize the nature of work performed and job responsibilities.
Employer (3)
Employment Dates
From To
Wages
Start End
Street Address
Position Title and Duties
City and State
Phone Number
Reason for Leaving
Name and Title of Immediate Supervisor
Summarize the nature of work performed and job responsibilities.
Employer (4)
Employment Dates
From To
Wages
Start End
Street Address
Position Title and Duties
City and State
Phone Number
Reason for Leaving
Name and Title of Immediate Supervisor
Summarize the nature of work performed and job responsibilities.
Specify the above employers we may contact for reference checks:

Employer
May we contact?
Name of Supervisor to Contact
Phone Number
Email Address
(1)
(2)
(3)
(4)
EMERGENCY NOTIFICATION
Contact Name
Phone No. (Include Area Code)
APPLICANT'S STATEMENT / AGREEMENT
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE AGREEING, AND RETURN THE APPLICATION
EMPLOYMENT ELIGIBILITY

If offered employment with Humphrey Products, I understand that my employment is contingent upon the presentation of documents establishing my identity and eligibility to work in the United States.


DRUG SCREENING AND POLICY STATEMENT

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


EMPLOYMENT AGREEMENTS / RESTRICTIONS

Are you bound by any confidentiality, non-disclosure, non-compete or patent agreements, or any other employment agreements of obligations limiting your work or requiring you to obtain approvals from or assign intellectual property to a current or former employer?

If yes, please explain.


CONDITIONS OF EMPLOYMENT

I understand that Humphrey Products is an "at will" employer. Accordingly, I understand that my employment is terminable at the will of either myself or Humphrey Products, that I am not being employed for any specified time, and that this application is not, nor is it intended to be, a contract for continued employment.

Any time after a conditional offer for employment, or during employment if hired, I authorized any physician or health care provider to release information advising the company (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 understand that this application for employment is for the specific position for which I am applying. Applicants wishing to be considered for employment beyond this period should inquire as to whether applications are being accepted at this time.
Name as Shown on Social Security Card
Date of Application
10/14/2019

UPLOAD A RESUME AND UP TO TWO ADDITIONAL FILES BELOW AND THEN CLICK SUBMIT.



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