APPLICATION FOR EMPLOYMENT
 
Thiele Kaolin Company is an Equal Opportunity Employer and does not discriminate against any individual in any phase of employment in accordance with the requirements of local, state, and federal law.
 
*Indicates Required fields

PERSONAL INFORMATION
 
 
Last Name*: First Name*: Middle Name:
 
Present Address
Street*: City*: State*: Zip*:
 
Permanent Address
Street: City: State: Zip:
 
Phone Number*: 1Are you 18 years of age or older?*
 
Alt. Phone Number: Email Address:
 
If related to anyone in our employ, State Name and Department: Referred by:
 
 
Employment Desired Position: Date you can start: May we inquire of your present employer?
   Yes    No
 
1  The Age Discrimination in Employment Act of 1967  prohibits discrimination on the basis of age with respect to individuals who are 40 or above.

EDUCATION
Education

Name and Location of School

Years Attended

Date Graduated

Subjects Studied

GRAMMAR SCHOOL

Name:

Location:

 

HIGH SCHOOL

Name:

Location:

 

COLLEGE

Name:

Location:

 

OTHER SCHOOL

Name:

Location:

 
Subject of Special Study or Research Work:
 
U.S. Military or Naval Service: Rank: Skills Acquired while in Service:

FORMER EMPLOYERS

List below your last four employers, starting with LAST ONE FIRST
Date (Month/Year) Name and Address of Employer Salary Position Reason for Leaving
From: Name:
To: Address:
 
From: Name:
To: Address:
 
From: Name:
To: Address:
 
From: Name:
To: Address:

REFERENCES
List below THREE persons not related to you, whom you have known at least one year
Name Address and Phone Number Business Years Acquainted
Reference #1*:
Address*:
Phone*:
   
 
Reference #2: Address:
Phone:
   
 
Reference #3: Address:
Phone:
 

ADDITIONAL BACKGROUND INFORMATION
In Case of Emergency Notify
Name: Address: Phone Number:
 
2Have you ever been convicted of a crime*?
If so, provide details:
 
2  A conviction does not automatically disqualify applicants from employment with Thiele. Thiele will evaluate the specific facts and offense in each case.

PRODUCTION JOB APPLICANT PRE-SCREENING CHECKLIST
Listed below are general production requirements. Please pick your present level of ability and willingness to perform.
 
1.  Ability to work rotating shifts Not Able Some level  High level
2.  Willing to wear earplugs Not Able Some level  High level
3.  Willing to work weekends Not Able Some level  High level
4.  Able to work outdoors Not Able Some level  High level
5.  Willing to use safety equipment (i.e. hardhat, safety glasses) Not Able Some level  High level
6.  Able to work overtime Not Able Some level  High level
7.  Able to work independently Not Able Some level  High level
8.  Able to use basic shop tools Not Able Some level  High level
9.  Willing to work without close supervision Not Able Some level  High level
10. Able to climb ladders or high stairway Not Able Some level  High level
11. Able to read and understand instructions Not Able Some level  High level
12. Able to do basic arithmetic Not Able Some level  High level
13. Willing to work various jobs Not Able Some level  High level
14. Able to express thoughts in writing Not Able Some level  High level
15. Able to get to and from work Not Able Some level  High level
16. Willing to work as part of a team Not Able Some level  High level
17. Willing to work without strong supervision Not Able Some level  High level
18. Able to do a job requiring a high degree of physical endurance Not Able Some level  High level
19. Willing to work in hot and humid working environment Not Able Some level  High level

PLEASE READ CAREFULLY

APPLICANT CERTIFICATION AND AGREEMENT
 
I authorize Thiele Kaolin Company to conduct inquiries to companies, schools and individuals named in this application. I release Thiele Kaolin Company as well as these organizations and individuals from liability for the conduct of these inquiries including the furnishing of information. I certify that the information contained in this application is truthful and accurate. I understand and agree that any falsification, ommissions or misleading statements on this application or in my responses to questions asked during the interviewing or examination process will be grounds for not hiring me or immediate termination of employment if and whenever discovered. I also understand that the use of this application does not indicate that there are any positions open and does not in any way obligate the company on a contractual basis or otherwise. Further, if hired, I understand that I will be an employee at will and will be subject to dismissal at any time with or without cause.