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Applicant Information

Name*:

Date of Application*:

Street Address*:

City*:

State* Select a State Pennsylvania Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip Code*:

Email Address*:

Phone Number*: Home   Work   Cell

Phone Number 2: Home   Work   Cell

Position Applied for* Select Bindery Press Room Electrician Other 1st Shift   2nd Shift   3rd Shift

Date Available to Start*

Desired Salary*:

Are you 18 years of age or older? Yes    No

Are you legally eligible to be employed in the United States? Proof of identity and eligibility will be required upon employment.
Yes   No

Have you ever worked at Maple Press? Yes    No

If yes, when?

Do you know any acquaintances or relatives employed by the at Maple Press? Yes    No

If yes, who?

Have you been convicted of a felony, and/or misdemeanor within the past seven (7) years? (You should not report convictions that have been annulled, pardoned, expunged, or sealed.) Maple Press understands that certain criminal convictions may have no reasonable relationship to the functions or responsibilities of the job in question. For this reason, a conviction record will not necessarily prevent employment. Factors such as age and time of the offense, seriousness, the nature of the position sought, the nature of the violation, and rehabilitation will be taken into account. Yes    No

If yes, please give the conviction date and nature of the offense:

How were you referred to Maple Press?*

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A production job at our company will require you to be able to work safely around machinery, lift weights of thirty (30) pounds and above at chest level to floor on a regular basis, and use hand and finger dexterity.

If applicable, are you able to perform these functions listed above with or without reasonable accommodation? Yes    No

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Military Service

Branch

From:

To:

Type of Discharge:

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Education

School:

Address:

Did you graduate? Yes   No

Degree:

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School:

Address:

Did you graduate? Yes   No

Degree:

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Additional Training, Education or Experience:

Previous Employment History

Please give accurate, complete full-time and part-time employment information. Start with your present or most recent employer.

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Job 1

Dates of Employment:

From:

To:

Position:

Company:

Street Address:

City:

State: Select a State Pennsylvania Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip Code:

Supervisor Name:

Supervisor Title:

Phone Number:

Starting Title:

Starting Salary:

Ending Title:

Ending Salary:

Reason for Leaving:

May we contact your current employer? Yes    No

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Job 2

Dates of Employment:

From:

To:

Position:

Company:

Street Address:

City:

State: Select a State Pennsylvania Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip Code:

Supervisor Name:

Supervisor Title:

Phone Number:

Starting Title:

Starting Salary:

Ending Title:

Ending Salary:

Reason for Leaving:

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Job 3

Dates of Employment:

From:

To:

Position:

Company:

Street Address:

City:

State: Select a State Pennsylvania Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip Code:

Supervisor Name:

Supervisor Title:

Phone Number:

Starting Title:

Starting Salary:

Ending Title:

Ending Salary:

Reason for Leaving:

Applicant's Statement

Maple Press does not discriminate in employment, educational programs, and activities on the basis of race, national origin, color, creed, religion, sex, age, disability, veteran status, sexual orientation, gender identity, or associational preference. Non-discrimination does not guarantee an employee or member of the public any rights not otherwise provided by law.

By the applicant entering their name in the box below, they are electronically signing this application and it carries the same legal value as if it were signed by the applicant in person.