Job Application: General Application

Fields marked with an asterisk (*) must be filled out before submitting.

PERSONAL DETAILS

First Name *
Middle Name
Last Name *
Social Security Number *
Email Address *
Present Address *
City *
State *
Zip Code *
Permanent Address *
City *
State *
Zip Code *
Phone Number *
Are you 18 years old or older? *	Yes No
Describe any U.S. Military Service	Branch, rank, nature and date of discharge.
Are you presently in the United States armed forces, active or reserve? If so, identify unit and any service obligations.
Have you ever been convicted of a crime or are you presently charged with a felony? *	Yes No
If so, where and when, and explain circumstances.

EMPLOYMENT DESIRED

Position
Date you can start *
Salary Desired *
Are you Employed Now? *	Yes No
If so, may we inquire of your present employer?	Please provide contact information.
Have you ever applied to Hadley before? *	Yes No
Where?	Elkhart, IN Grandville, MI Europe Other
When?	Please explain.
Have you ever worked for Hadley before? *	Yes NO
Do you have any relatives employed by Hadley? If so, please tell us who they are.
Do you have any activities, commitments or responsibilities (for example, school, other employment, etc.) that might interfere with your ability to work full time, including overtime, in the position for which you are applying? *	Yes No
If so, please explain.

FORMER EMPLOYMENT

List below last four employers, starting with the most recent.

FORMER EMPLOYER 1

Date from/to (e.g. 01/2018 – 05/2019)
Name and Address
Salary
Position/Title
Reason for Leaving

FORMER EMPLOYER 2

Date from/to (e.g. 01/2018 – 05/2019)
Name and Address
Salary
Position/Title
Reason for Leaving

FORMER EMPLOYER 3

Date from/to (e.g. 01/2018 – 05/2019)
Name and Address
Salary
Position/Title
Reason for Leaving

FORMER EMPLOYER 4

Date from/to (e.g. 01/2018 – 05/2019)
Name and Address
Salary
Position/Title
Reason for Leaving
Describe fully the nature of the work in your present (or most recent) job.
Which of your jobs did you like best?
Why did you like it best?
What special skills or knowledge do you have that will aid you in qualifying for employment?

EDUCATION

Grammar School
Name and Location of School
Number of years attended
High School
Name and Location of School
Number of years attended
Did you graduate?	Yes No
College
Name and Location of College
Number of years attended
Did you graduate?	Yes No
Subjects Studied
Trade, Business or Correspondence School
Name and Location of School
Number of years attended
Did you graduate?	Yes No
Subjects Studied

Other

Subjects of Special Study or Research Work

REFERENCES

Give the names of three people, not related to you, whom you have known at least one year.

Reference 1

Name
Address
Business Field
Years Acquainted

Reference 2

Name
Address
Business Field
Years Acquainted

Reference 3

Name
Address
Business Field
Years Acquainted

In case of emergency notify:

Name
Address
Phone Number

TERMS OF EMPLOYMENT

READ CAREFULLY AND CHECK THE BOX BELOW IF YOU AGREE TO THESE TERMS OF EMPLOYMENT I agree that my employment with the Company will be at will and may be terminated by me or the Company at any time, with or without cause. I agree that no one other than the President of the Company, in a written contract, has any authority to limit the Company’s right to terminate employment at will, or to offer employment other than on an at-will basis. I agree that the contents of any office, locker or desk or equipment or other Company property I may use, and any of my own property I bring onto the Company’s premises (including, without limitation, cars, packages, and purses), may be inspected by the Company at any time, and I waive any claims against the Company or its agents relating to such inspection. I agree that I will not disclose to anyone or use for my own purposes any of the Company’s confidential or proprietary information, either during or after my employment, except at the request and for the benefit of the Company. I agree that information about the Company’s customers, vendors, sources of supply, pricing, costs, and other financial information, products, services, methods of operation, marketing, engineering methods, production, and the like is confidential and proprietary information that belongs to the Company. If my employment with the Company ends, I will not retain any copies or summaries of any such information, but will promptly return all such information to the Company. I also agree that I will disclose and assign to the Company any invention, design or process that I conceive or develop while employed by the Company relating to the Company’s business or to any product or service offered or being developed by the Company, and that all such inventions, designs or processes belong to the Company. I agree to submit to physical examinations permitted by law before and during my employment, at the request and expense of the Company, and I agree to disclose all information lawfully requested at such examinations about my physical and mental condition and medical history. I also agree that before and during my employment, at the request and expense of the Company, I will cooperate in such lawful medical tests (including blood, urine or other testing) as the Company requests to check for drugs or alcohol in my system. I waive any claims against the Company or its agents or any testing agency retained by the Company or its agents relating to any such testing, or from lawful decisions made regarding my employment or termination of employment based upon the results of such testing or analysis. I agree that except as prohibited by statute the Company may, during or after my employment, disclose or discuss any information or opinions relating to me or my employment to employees of the Company or third parties. I waive written or other notice of any such disclosure, including disclosure of disciplinary matters, and I waive any claims against the Company or its agents relating to any such disclosure or discussion. I agree that I will not commence any action or lawsuit relating to my employment with the Company, or the termination of my employment, more than 12 months after the termination of my employment, and I agree to waive any statute of limitations to the contrary. I understand that this means that even if the law would give me the right to wait a longer time to make a claim, I am freely and knowingly waiving that right, and that any claims not brought within 12 months after my employment ends will be barred. I waive any right to a jury trial if I ever sue the Company relating to my employment with the Company. I understand that this means that even if the law would give me the right to have a jury decide my claims, I am freely and knowingly waiving that right and agree to have my claims heard and decided by a judge instead. I agree to the above terms of employment. I agree that if any of the above terms is ever found to be legally unenforceable as written, such invalidity will not affect the validity of the rest of this agreement, and such term shall be limited to allow its enforcement as far as legally possible. I agree that no one other than the President of the Company, by a written directive, has any authority to modify the above terms of employment, or to make any exception to them, or to offer employment on any other terms. I agree that I will be bound by and will adhere to any other rules and policies issued by the Company, including all rules and policies contained in the Company’s employee handbook.
Do you agree to the Terms of Employment above?	Yes No

READ CAREFULLY AND CHECK THE BOX BELOW IF YOU AGREE TO THESE TERMS OF EMPLOYMENT I agree that my employment with the Company will be at will and may be terminated by me or the Company at any time, with or without cause. I agree that no one other than the President of the Company, in a written contract, has any authority to limit the Company’s right to terminate employment at will, or to offer employment other than on an at-will basis. I agree that the contents of any office, locker or desk or equipment or other Company property I may use, and any of my own property I bring onto the Company’s premises (including, without limitation, cars, packages, and purses), may be inspected by the Company at any time, and I waive any claims against the Company or its agents relating to such inspection. I agree that I will not disclose to anyone or use for my own purposes any of the Company’s confidential or proprietary information, either during or after my employment, except at the request and for the benefit of the Company. I agree that information about the Company’s customers, vendors, sources of supply, pricing, costs, and other financial information, products, services, methods of operation, marketing, engineering methods, production, and the like is confidential and proprietary information that belongs to the Company. If my employment with the Company ends, I will not retain any copies or summaries of any such information, but will promptly return all such information to the Company. I also agree that I will disclose and assign to the Company any invention, design or process that I conceive or develop while employed by the Company relating to the Company’s business or to any product or service offered or being developed by the Company, and that all such inventions, designs or processes belong to the Company. I agree to submit to physical examinations permitted by law before and during my employment, at the request and expense of the Company, and I agree to disclose all information lawfully requested at such examinations about my physical and mental condition and medical history. I also agree that before and during my employment, at the request and expense of the Company, I will cooperate in such lawful medical tests (including blood, urine or other testing) as the Company requests to check for drugs or alcohol in my system. I waive any claims against the Company or its agents or any testing agency retained by the Company or its agents relating to any such testing, or from lawful decisions made regarding my employment or termination of employment based upon the results of such testing or analysis. I agree that except as prohibited by statute the Company may, during or after my employment, disclose or discuss any information or opinions relating to me or my employment to employees of the Company or third parties. I waive written or other notice of any such disclosure, including disclosure of disciplinary matters, and I waive any claims against the Company or its agents relating to any such disclosure or discussion. I agree that I will not commence any action or lawsuit relating to my employment with the Company, or the termination of my employment, more than 12 months after the termination of my employment, and I agree to waive any statute of limitations to the contrary. I understand that this means that even if the law would give me the right to wait a longer time to make a claim, I am freely and knowingly waiving that right, and that any claims not brought within 12 months after my employment ends will be barred. I waive any right to a jury trial if I ever sue the Company relating to my employment with the Company. I understand that this means that even if the law would give me the right to have a jury decide my claims, I am freely and knowingly waiving that right and agree to have my claims heard and decided by a judge instead. I agree to the above terms of employment. I agree that if any of the above terms is ever found to be legally unenforceable as written, such invalidity will not affect the validity of the rest of this agreement, and such term shall be limited to allow its enforcement as far as legally possible. I agree that no one other than the President of the Company, by a written directive, has any authority to modify the above terms of employment, or to make any exception to them, or to offer employment on any other terms. I agree that I will be bound by and will adhere to any other rules and policies issued by the Company, including all rules and policies contained in the Company’s employee handbook.

Do you agree to the Terms of Employment above?

Yes
No

AUTHORIZATION AND WAIVER

I authorize and request my former employers, references, educational institutions, and any credit agencies or reporting services that have information about me to give the Company any information and opinions about me in their possession and which may lawfully be disclosed. I hereby waive written notice of such release of information and opinions, and I release such former employers, references, educational institutions, and credit agencies or reporting services from any liability or claim relating to such release of information and opinions. I also authorize and request federal, state, and local governmental agencies to release to the Company any information requested concerning any criminal convictions on my record. A photocopy of this signed authorization and waiver will be valid as an original.
Do you agree to the Authorization and Waiver above?	Yes No
Please Enter Your Name Indicating that you accept Terms of Employment and the Authorization and Waiver herein.