Niagara Caps & Plugs Employment Opportunities

Niagara Caps & Plugs Company

7090 Edinboro Road
Erie, PA 16509

APPLICATION FOR EMPLOYMENT

Niagara Plastics, LLC is an equal opportunity employer. We consider applicants for all positions without regard to age, race, creed, color, national origin, gender, disability, marital status or any other legally protected status pursuant to relevant federal, state and local laws.

Position(s) Applied for:		Date of application
Shift(s) Preferred:
How were you referred to us?
Employee	Government Employment Agency	Advertisement - Source
Relative	Private Employment Agency	Walk-in
Other

State name(s) of any relative already employed by Niagara Plastics, LLC:

On what date would you be available for work?		Salary Desired: $

PERSONAL INFORMATION (Required Information)

Last Name:
Middle Name:
First Name:
Address:
City, State, Zip:
Phone: (include area code)

Are you under 18 years of age? yes No
If yes, can you provide required proof of your eligibility to work? yes No

If "No", Please explain:

Have you ever been employed with Niagara Plastics, LLC before? yes No

If Yes, give dates:

Are you prevented from lawfully becoming
employed in this country because of Visa or Immigration Status? yes No
(Proof of citizenship or immigration status will be required upon employment.)

Type of employment desired: Full-time Part-time Temporary Shift work Internship

Are you currently employed? yes No

If yes, may we contact your current employer? yes No

Will you work overtime if job requires it? yes No

Have you been convicted of a felony within the last 7 years?
Answering “yes” does not necessarily disqualify an applicant from employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position being applied for will be taken into account. yes No

If "Yes", please explain:

EMPLOYMENT HISTORY

Provide the following information of your past and current employers, starting with the most recent. If you need additional space, please continue on a separate sheet of paper.

Employer:	Dates Employed		Summarize the Type of Work Performed and Job Responsibilities
Address:	From	To

Telephone:
Job Title:	Hourly Rate/Salary
Supervisor:	Starting	Final

Reason For Leaving:

Employer:	Dates Employed		Summarize the Type of Work Performed and Job Responsibilities
Address:	From	To

Telephone:
Job Title:	Hourly Rate/Salary
Supervisor:	Starting	Final

Reason For Leaving:

Employer:	Dates Employed		Summarize the Type of Work Performed and Job Responsibilities
Address:	From	To

Telephone:
Job Title:	Hourly Rate/Salary
Supervisor:	Starting	Final

Reason For Leaving:

REFERENCES

List name and telephone number of three business/work references who are not related to you and not previous supervisors.

1	Name:
	Address:
	Phone:
	City, State, Zip

2	Name:
	Address:
	Phone:
	City, State, Zip

3	Name:
	Address:
	Phone:
	City, State, Zip

EDUCATION

	Name and Location Of School	Did you Graduate?	Course of Study/ Degree Received
Grammar School		yes No
High School		yes No
College / University		yes No
Night School		yes No
Trade, Business or Other School		yes No

Additional Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

THE FOLLOWING STATEMENT NEEDS TO BE READ AND SIGNED BY THE APPLICANT IN ORDER TO BE ELIGIBLE FOR EMPLOYMENT.

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with Niagara Plastics, LLC is true, complete and correct.

I expressly authorize, without reservation, Niagara Plastics, LLC, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to verify the accuracy of all information provided by me in this application. 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 such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

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

I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with Niagara Plastics, LLC is of an “at will” nature, which means that if I am hired I am free to resign at any time, with or without cause, and without prior notice. Niagara Plastics, LLC reserves the same right to terminate my employment at any time, with or without cause and without prior notice.

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

I also understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to cancel further consideration of this application or immediately discharge me from employment with Niagara Plastics, LLC whenever it is discovered.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement:
(Required Information)
Please check box if read
Signed:
Date:

QS 9000 - ISO 9001 Certified, Copyright 2004 Niagara Caps & Plugs

Niagara Caps & Plugs • 7090 Edinboro Road • Erie, PA, USA 16509-4497
Phone: 1-800-458-0465 or 1-814-868-3671 • Fax: 1-800-358-4391 or 1-814-864-2423 • e-mail: info@NiagaraCapsandPlugs.com

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