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Keymark Corporation of Florida
Employment Application
Drug Free Work Place/Equal Opportunity Employer

We appreciate your interest in our Company and are sincerely interested in your qualifications.

Please complete all parts of this form and answer all questions accurately. Any false statements or omissions will prevent employment or cause dismissal if employed whenever same may be discovered. Applications are kept active for 60 days and must be renewed for further consideration.


WE ARE AN EQUAL OPPORTUNITY EMPLOYER

APPLICANT'S STATEMENT

I understand that the Company is committed to providing equal opportunity and all employment practices, including but not limited to selection, hiring promotion, transfer, and compensation to all qualified applicants and employees without regard to age, race, color, national origin, ancestry, sex, sexual orientation, gender identity, pregnancy, religion, handicap or disability, service member status, genetic information, or any other category protected by federal, state, or local law.


I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at will at any time with or without notice or reason, and the Company has the same right. No one other than the President or Executive Vice President has authority to modify this relationship or make any agreement to the contrary. Any such modification or agreement must be in writing.


I understand that the Company reserves the right to require me to submit to a drug test, alcohol test and / or medical examination in accordance with the law. I further understand that the Company may contact my previous employers and any organization for which I performed certified work on a volunteer basis and I authorize those employers and organizations to disclose to the Company all records and other information pertinent to my employment or volunteer work with them. I release my previous employers from any liability as a result of their disclosure of information about me to the Company. I also authorize the Company to provide truthful information concerning my employment with it to my future prospective employers and I agree to hold it harmless for providing such information.


I further understand that if employed I will be on a 90-day introductory period. I further understand that completion of the introductory period does not confer any expectation of continued employment, and that if employed, my employment will be for no definite period and "at-will."


By signing below, I certify that all of the information that I provide on this application and in any interview will be true, complete and accurate in all respects, and I agree that if the information is found to be false, misleading, or unsatisfactory in any respect (in the Company's judgment) that I will be disqualified from consideration for employment or subject to immediate dismissal if discovered after I am hired.


I certify that I have received a written notification that the Company may obtain a consumer report or reports on me. I authorize this Company to obtain such a report or reports for use in connection with my application for employment and for other employment related reasons. If hired, this authorization shall remain on file and serve as I'm going authorization for procurement of employment related consumer reports at any time during my appointment. I understand that the term "consumer report" includes, but is not limited to, credit checks, criminal background checks, department of motor vehicle reports, and investigative consumer reports. I further understand that the term "investigative consumer report" means a report and which information on my character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with my neighbors, friends, or associates, or with others with whom I am acquainted or who may have knowledge concerning any such items of information.


I further understand that it is unlawful to require or administer a lie detector test as a condition of my employment or continued employment. An employer who violates this law shall be subject to criminal penalties penalties and civil liability.

DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THIS STATEMENT

Complete Name of Applicant: Date:


If hired, can you provide proof of identity and authorization to work in the United States?

PERSONAL INFORMATION

Date:


Name: Last four digits of your Social Security #:


Present Address:

City: State: Zip:

How long have you lived there? years, months


Previous Address:

City: State: Zip:

How long did you live there? years, months


Phone Are you 18 years or older?


EMPLOYMENT DESIRED

Desired Shift Schedule:

Desired job Date you can start Salary desired


Ever been employed by this company before? Where? When?

Do you have any friends or relatives working here? Name? Relationship?

Ever applied to this company before? When? (Approximately)

EMPLOYMENT EXPERIENCE

For full consideration enter all previous employment experience. Use of the statement "refer to resume" is not acceptable. Start with your present employer and list backward chronologically in order.

Do you have employment experience?

Employer: Phone: Work Performed:
Address: Dates employed: Mo./Yr.
From:
To:
Job Title: Hourly Rate/Salary:
Starting:
End:
Supervisor:
Reason for Leaving:
Employer: Phone: Work Performed:
Address: Dates employed: Mo./Yr.
From:
To:
Job Title: Hourly Rate/Salary:
Starting:
End:
Supervisor:
Reason for Leaving:
Employer: Phone: Work Performed:
Address: Dates employed: Mo./Yr.
From:
To:
Job Title: Hourly Rate/Salary:
Starting:
End:
Supervisor:
Reason for Leaving:
Employer: Phone: Work Performed:
Address: Dates employed: Mo./Yr.
From:
To:
Job Title: Hourly Rate/Salary:
Starting:
End:
Supervisor:
Reason for Leaving:

List all other employers you have had that are not listed above:


Have you ever been terminated, resigned in lieu of termination, or asked to resign from any job?

If yes, please explain circumstances:


Please explain fully any gaps in your employment history:


Are you employed now? If so, may we inquire of your present employer?


Have you ever used another name?

If yes, please list them below:


Is there any additional information relative to change of name, use of assumed name, or nickname necessary to enable a check on your work and educational record?

If yes, please explain:


If hired, can you furnish proof that you are over 18 years of age?


Are you capable of satisfactorily performing the essential job duties required of the position for which you are applying?


Do you have adequate transportation to and from work?


How many days of work have you missed in the last three years due to reasons other than paid holidays and vacation?

Year: Number of days:

Year: Number of days:

Year: Number of days:

SERVICE RECORD

Branch of Service Rank at Discharge
List Duties (include schools and training)
Reason for Leaving

PREVIOUS EXPERIENCE

Please describe any experience you have which you feel would assist you in performing the job for which you are applying:


EDUCATION

 Name & Location of schoolYears CompletedDid you Graduate?Course of Study / MajorSpecialized Training / Skills
Elementary
High School
College / University
Graduate / Professional
Trade / Correspondence
Other

PERSONAL REFERENCES

Please list persons who know you well -- not previous employers or relatives

NameOccupationAddressRelationshipPhone No.Years Known

DRIVING INFORMATION

(complete only if driving is an essential function of the job for which you are applying)

Do you have a current driver's license?

State: License No: Expiration Date:


BACKGROUND INFORMATION

Have you ever pled guilty, nolo contendere, or no contest to, or been convicted of, a crime? If yes please, explain:

The existence of a criminal record does not constitute an automatic bar to employment.



APPLICANT'S CERTIFICATION

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY.


I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.


Complete Name of Applicant Date


You must fully and accurately complete this Employment Application. Incomplete applications will not be considered. If you do not have all the information with you at this time (dates, telephone numbers, addresses etc.) please keep this application and return it when it is completed.
Mail to: Human Resources, Keymark Corporation, 2540 Knights Station Road, Lakeland, FL 33810

This application will be considered active for 60 days. If you wish to be considered after that time you must complete a new Employment Application.


If you would like an email confirmation that your application was filed successfully, please enter your email address below. We will not use your email address for any purpose other than to contact you regarding your application.
Email Address:


Attach A Resume (optional)

You must click the Submit Application button above or we will not receive it