5932 Solomons Island Road
P. O. Box 30
Tracy's Landing, MD 20779
Phone: 410-867-7577
Fax: 410-867-4340
Application For Employment
www.smcinc.biz
PERSONAL INFORMATION
Date:
Name:
Last
First
Middle
Current Address:
How long at above address?
Social Security #
Phone No.:
Alt. No. #:
Postion(s) Applying For:
Desired Salary : $
Will you travel if needed?
Yes
No
(Please specify per hour or per year)
Employment Desired:
Full Time
Part-Time
Full or Part-Time
Are you legally eligible for employment in this country?
No
Yes
Do you have a valid driver's license?
No
Yes
Will you work overtime if required?
No
Yes
Will you travel if job requires it?
No
Yes
Date Available to Start Work:
Have you ever been employed with SMC, Inc. before?
No
Yes
If yes, explain when, and the reason for departure.
Have you ever been convicted of a crime?
No
Yes
Answering yes will not automatically bar your consideration for employment.
**If yes, explain number of convictions, dates, and the imposed sentencing.
SMC, Inc...........................Where Safety Makes Cents.
EDUCATIONAL BACKGROUND
Type of School
Name
Location
# of Years Attended
List Degree Received
High School
College
Business / Trade
Other
SKILLS AND QUALIFICATIONS
Summarize any special training, skills, licenses and/or certificates that may assist you in performing
the position for which you are applying.
EMPLOYMENT BACKGROUND
Please list your employment history for the past 5 years, beginning with your most recent job held.
Name of Employer:
From:
Starting Pay:
Address:
To:
Final Pay:
Name of Last Supervisor:
Phone No.:
Starting Position:
Ending Position:
Duties performed while there:
Reason for departure:
May we contact this employer for a reference?
No
Yes
Name of Employer:
From:
Starting Pay:
Address:
To:
Final Pay:
Name of Last Supervisor:
Phone No.:
Starting Position:
Ending Position:
Duties performed while there:
Reason for departure:
May we contact this employer for a reference?
No
Yes
Name of Employer:
From:
Starting Pay:
Address:
To:
Final Pay:
Name of Last Supervisor:
Phone No.:
SMC, Inc...........................Where Safety Makes Cents.
Continued from previous page...
Starting Position:
Ending Position:
Duties performed while there:
Reason for departure:
May we contact this employer for a reference?
No
Yes
Name of Employer:
From:
Starting Pay:
Address:
To:
Final Pay:
Name of Last Supervisor:
Phone No.:
Starting Position:
Ending Position:
Duties performed while there:
Reason for departure:
May we contact this employer for a reference?
No
Yes
Name of Employer:
From:
Starting Pay:
Address:
To:
Final Pay:
Name of Last Supervisor:
Phone No.:
Starting Position:
Ending Position:
Duties performed while there:
Reason for departure:
May we contact this employer for a reference?
No
Yes
REFERENCES
List contact information 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.
PHONE
YEARS
NAME
TITLE
RELATIONSHIP
TO YOU
NUMBER
KNOWN
RELATED INFORMATION
To what job-related organizations (professional, trade, etc.) do you belong? List
special accomplishments, publications, awards, etc. Exclude information that would reveal race, color, religion, sex, national
origin citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.
SMC, Inc...........................Where Safety Makes Cents.
Continued from previous page...
If you have additional work related information continue below:
In your current or a prior job, have you ever written instructions or directions to be followed by employees or
customer?
No
Yes
Not Applicable
If yes, please explain:
Is there any other job-related information you want us to know about you?
APPLICANT 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 30 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 my be required by law. This application does not constitute an agreement or contract
for employment for any specified period or definite 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 contrary
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 U.S. 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 if 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 SUBMIT UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Date:
SMC, Inc...........................Where Safety Makes Cents.