Employment Application

An English Employment app for Jasper Plastic Solutions

  • MM slash DD slash YYYY

  • Education

  • Please list the Name and Location of your High school as well as the Years Attended and Subjects Studied. (click the + to add another row)
    Name and LocationYears AttendedSubjects studied 

  • Name and Location of the College / University you studied at as well as the years attended, if you graduated, subjects studied and if applicable - your degree. (click the + to add another row)
    Name / LocationYears AttendedDid you Graduate?Degree 

  • Name and Location of any other secondary schools you studied at as well as the years attended, if you graduated, subjects studied and if applicable - your degree. (click the + to add another row)
    Name / LocationYears AttendedDid You Graduate?Degree 

  • Employment History

  • Please list your former Employers, Salary, Position, Duties and Reason for Leaving. (click the + to add another row)
    Employer NameSupervisorPositionDutiesReason for LeavingStart / End dateLast Wage 

  • References

  • Give below the names of three people not related to you, whom you have known for at least one year. (click the + to add another row)
    NamePhoneBusinessYears Known 

  • Have you ever been CONVICTED, PLEAD GUILTY or NO CONTEST to a FELONY?
  • Please Explain.

  • Equal access to programs, services and employment is available to all persons. Those applicants requiring a reasonable accommodation to the application and/or interview process should notify a representative of Human Resources Department. We are an equal opportunity employer.

  • Authorization

    I certify that all the information submitted by me on this application is true and complete, and I understand that if any false or misleading information, omissions or misrepresentations are discovered, my application may be rejected, and if I am employed, my employment may be terminated at anytime. If hired, I agree to conform to the Company’s rules and regulations, and I understand that these rules and/or the employee handbook do not form a contract of employment either express or implied, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at anytime, at either my or the Company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause and with or without notice, at anytime by the Company. I understand that no Company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the forgoing. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, résumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives for seeking, gathering and using truthful and no defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that this application remains on file for one year and active for 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application. I also understand that, if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States as required by Federal Immigration laws. This Company does not tolerate unlawful discrimination or harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable Federal, State or local law. No question on this application is used to limit or exclude an applicant from employment consideration on any basis prohibited by applicable federal, state or local laws.

  • Typing your name and the date in the below fields are considered an electronic signature.
    First NameLast NameDate

Jasper Plastics Solutions

501 West Railroad Ave   Syracuse, IN 46567

phone: 574.457.2062

fax: 574.457.2069