ON-LINE APPLICATION FOR EMPLOYMENT

Also, please email your resume, if available, to hr@chromate.com

Position Applying For:

                              Date:

PERSONAL INFORMATION

Last Name:   First Name:

Address:

       City:

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

Home Phone:     Cell Phone:

Are you legally eligible for employment in the US?

How did you learn of our organization?

*Have you ever been convicted of a crime (felony or misdemeanor)?
  *Answering yes to this question does not constitute an automatic bar to employment.

*Have you ever been arrested for a crime that is currently pending against you?
  *Answering yes to this question does not constitute an automatic bar to employment.

Special skills possessed or training received that would be beneficial for the position:

EDUCATION

Are you a High School Graduate or GED:

Name of College and Location:

Course of Study:     Did you graduate?

No. of Years Completed:     Degree/Diploma:

EMPLOYMENT -- Please complete starting with your most current position

1. Company Name:

    Company Address:

    Company Phone:      Last Weekly Rate of Pay:

    Dates of Employment:      Reason for Leaving:

    State Job Title and Describe Your Work:

2. Company Name:

    Company Address:

    Company Phone:      Last Weekly Rate of Pay:

    Dates of Employment:      Reason for Leaving:

    State Job Title and Describe Your Work:

3. Company Name:

    Company Address:

    Company Phone:      Last Weekly Rate of Pay:

    Dates of Employment:      Reason for Leaving:

    State Job Title and Describe Your Work:

4. Company Name:

    Company Address:

    Company Phone:      Last Weekly Rate of Pay:

    Dates of Employment:      Reason for Leaving:

    State Job Title and Describe Your Work:

APPLICANT'S STATEMENT

I certify that the information provided by me on this application is accurate. I understand that if any false information, misrepresentations, or omission of facts are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time.

I certify that I have read and understand the Applicant's Statement Yes

Select a response for the information requested below.

EQUAL OPPORTUNITY INFORMATION

GENDER:   MALE          FEMALE

Providing this information is strictly voluntary and will be kept separate from your application. The law prohibits employers from adverse action against you because you choose not to provide this information. If you choose not to provide this information, select "Decline to Identify".

ETHNICITY:

Decline to Identify

WHITE (Not of Hispanic Origin)

AFRICAN AMERICAN/BLACK (Not of Hispanic Origin)

ASIAN (Not Hispanic or Latino)

NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER (Not Hispanic or Latino)

AMERICAN INDIAN or ALASKA NATIVE (Not Hispanic or Latino)

HISPANIC or LATINO

In addition, please e-mail your resume if available to chromatehr@aol.com