Application for Employment
Consistent with the requirements of various state and federal laws, it is the policy of this company not to discriminate because of age, sex, disability, race, religion, national origin or any other legally protected status. An equal opportunity employer (M/F/D/V).
Please note: Red icon denotes required fields
PERSONAL
	First Name
	Last Name
	Middle Name
	Present Address (Number, Street or Rural Route)
	City
	State
	Zip Code
	Telephone (Home)
	Telephone (Work)
	Permanent Address (If other than present)
	City
	State
	Zip Code
	Telephone
	Are you 18 years of age or older?	Yes No
	Are you legally authorized to work in the United States? If yes, proof is required within 3 days of hire	Yes No
	Do you have any relatives employed at this facility?	Yes No
	Have you ever been employed at this facility or another Avery Weigh-Tronix location?	Yes No
	Other names by which you have been known (for use in checking references)
	Have you ever been granted a security clearance by any government agency?	Yes No
	If yes, level of clearance:
	Have you ever been denied a security clearance by any government agency?	Yes No
	If yes, indicate when denied and by whom:
	Have you ever been convicted of a felony? (Federal, local or military) Conviction will not automatically disqualify you from employment	Yes No
	If yes, give date, charge and disposition:
MILITARY SERVICE
	Branch of Service
	Date Entered
	Date of Discharge
	Rank on Entering
	Rank/Rating at Discharge
	Major Duties
EDUCATION Please indicate all education (including high school), training and experience which you believe qualifies you for the position you are seeking.
	School Name & Address
	Was Degree or Certificate awarded?	Yes No
	Areas of Study/Type of Degree
	School Name & Address
	Was Degree or Certificate awarded?	Yes No
	Areas of Study/Type of Degree
	School Name & Address
	Was Degree or Certificate awarded?	Yes No
	Areas of Study/Type of Degree
	School Name & Address
	Was Degree or Certificate awarded?	Yes No
	Areas of Study/Type of Degree
PREVIOUS EMPLOYMENT Please account for all periods of employment and unemployment for the last seven years beginning with your present or most recent positions.
	Name and Address of present or last employer
	Telephone
	Dates of employment - Starting and Ending
	May we contact your present employer?	Yes No
	Immediate Supervisor
	Reason for leaving
	Starting Salary
	Final Salary
	Job Title and Responsibilities
	Name and Address of your next previous employer
	Telephone
	Dates of employment - Starting and Ending
	Immediate Supervisor
	Reason for Leaving
	Starting Salary
	Final Salary
	Job Title and Responsibilities
	Name and Address of your next previous employer
	Telephone
	Dates of employment - Starting and Ending
	Immediate Supervisor
	Reason for Leaving
	Starting Salary
	Final Salary
	Job Title and Responsibilities
WORK REFERENCES Please supply up to three (two required) work references we may contact freely by phone.
	Name of Reference
	Company Name
	Telephone
	Name of Reference
	Company Name
	Telephone
	Name of Reference
	Company Name
	Telephone
OTHER EXPERIENCE OR QUALIFICATIONS
	Please summarize other experience or qualifications (example: typing speed and accuracy)
TYPE OF WORK DESIRED
	Type of Work Desired
	Availability Date
	Salary Expected
	How did you hear about Avery Weigh-Tronix?	Newspaper Radio Friend Other
STATEMENT OF ACCURACY I certify that the information provided on this job application is true and complete to the best of my knowledge. I understand that any omissions or misrepresentations will be reason for withdrawal of a job offer or termination of employment whenever the omission or misrepresentation is discovered. I authorize the company to investigate all statements contained in this application for employment as may be necessary in arriving at an employment decision. (Note: Present employer will be contacted only when specific permission is granted or after acceptance of offer). I understand that I will be required to sign an agreement relating to the assignment of inventions to the company. I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this company is of an "at will" nature, which means that I may resign at any time and the company may discharge me at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged by the President of the company and Director of Human Resources of the company. I also understand that I am required to abide by all rules and regulations of the company. I have read, understand and agree to the above by checking the box and providing the date in the area below this statement.
	I have read, understand and agree to the above.
	Date
IMPORTANT NOTICE TO PROSPECTIVE APPLICANTS If offered employment, I understand that I will be required to produce appropriate documents as required. I understand that any offer of employment is contingent on satisfactory results on a preplacement medical exam and a drug and alcohol test. If I refuse to consent to any of these requirements, I will not be eligible for employment with Avery Weigh-Tronix. Individuals to whom a conditional offer of employment is made are advised not to resign from their current position until the results of the test are known. I have read, understand and agree to the above by checking the box and providing the date in the area below this statement.
	I have read, understand and agree to the above.
	Date
EQUAL EMPLOYMENT OPPORTUNITY DATA Completion of this section is entirely voluntary, and all information will remain confidential and will not affect your application for employment. We are required by law to collect this information for equal opportunity employment purposes, and it will not become part of your personnel record if you are hired by this company.
	Position Applied for
	Sex
	Race/Ethnicity
EQUAL EMPLOYMENT OPPORTUNITY DATA Government contractors must take affirmative action to employ and advance certain qualified individuals subject to the Rehabilitation Act of 1973 and the Vietnam Era Veterans Readjustment Act of 1974. Completion of the following section is entirely voluntary, and will assist in proper placement and reasonable accommodation. If you wish to be identified as qualifying for such placement or accommodation, please check where applicable.
	Vietnam Era Veteran
	Disabled Veteran
	Individual with a Disability