Online Employment Application Form: Centex Machining Corporation

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Resource Department.

*****Please fill out the application completely. Incomplete applications will be discarded and you will not be considered for a position

Position (s) Applied For:              Date of Application MM/DD/YYYY:

Last Name : Middle Name: First Name:     Social Security #:

Street Address:    City: State:     Zip:

Telephone #: Mobile/Beeper/Other #:    E-mail Address::

Referral Source (How did you hear about us?):

If you are under 18 and it is required, can you furnish a work permit?: ...........................................................................................................................................................Yes    No

If no, please explain:

Have you ever been employed here before? If yes, give dates and positions:      Yes No

Are you legally eligible for employment in this country?: ................................................................................................................................................................................ Yes No

Date available for work ............    What is your desired salary range?.............. ....................................................................$

Type of employment desired:          Full-Time             Part-Time               Temporary               Seasonal                 Educational Co-Op

Are you able to perform the essential functions of the job for which you applying (with or without reasonable accommodation)?:

This question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disability, particular accomodation, or whether accommodation is neccessary. These issues may be addressed at a later stage to the extent permitted by law:

Yes     No    Need more information about the job's "essential" functions" to respond

Driver's license number required if driving may be required in the job for which you are applying: .........................................     State

Answering "yes" to either of the following questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied will be taken into account.

Have you ever pleaded "guilty" or "no contest" to, or been convicted of a crime?.....................................................    Yes    No

If yes, please provide date(s).............................

Employment History:
_______________________________________________________________________________________________________________________________________________

Starting with your most recent employer, provide the following information.

Employer:           Telephone #:        Dates Employed (MM/YYYY):     to

Street Address:        City:    State:

Starting job title/final job title:                            Compensation (Starting): Hourly     Salary        $:     per

Immediate supervisor and title (for most recent position held):        Commission/Bonus/Other Compensation: $:
Why did you leave?                    Compensation (Final): Hourly     Salary        $:     per

May we contact for reference?: Yes     No      Later                                                                                    Commission/Bonus/Other Compensation: $:

Summarize the type of work performed and job responsibilities

________________________________________________________________________________________________________________________________________________

Employer:           Telephone #:        Dates Employed (MM/YYYY):     to

Street Address:        City:    State:

Starting job title/final job title:                            Compensation (Starting): Hourly     Salary        $:     per

Immediate supervisor and title (for most recent position held):        Commission/Bonus/Other Compensation: $:
Why did you leave?                    Compensation (Final): Hourly     Salary        $:     per

May we contact for reference?: Yes     No      Later                                                                                    Commission/Bonus/Other Compensation: $:

Summarize the type of work performed and job responsibilities

________________________________________________________________________________________________________________________________________________

Employer:           Telephone #:        Dates Employed (MM/YYYY):     to

Street Address:        City:    State:

Starting job title/final job title:                            Compensation (Starting): Hourly     Salary        $:     per

Immediate supervisor and title (for most recent position held):        Commission/Bonus/Other Compensation: $:
Why did you leave?                    Compensation (Final): Hourly     Salary        $:     per

May we contact for reference?: Yes     No      Later                                                                                    Commission/Bonus/Other Compensation: $:

Summarize the type of work performed and job responsibilities

_______________________________________________________________________________________________________________________________________________

Skills and Qualifications
Summarize any special traininig, skills, licenses and/or certificates that may assist you in performing the position for you are applying:

Computer Skills (Check appropriate boxes. Include software titles and years of experience.)

Word Processing         Years:      E-mail        Years:

Spreadsheet         Years:      Internet        Years:

Presentation         Years:      Other        Years:

________________________________________________________________________________________________________________________________________________

Educational Background
Starting with your most recent school attended, provide the following information.

School (include City & State)     Years Completed    Type (Diploma, Degree, Cert., GED, Other)

GPA/ Class Rank     Major/Minor

________________________________________________________________________________________________________________________________________________

School (include City & State)     Years Completed    Type (Diploma, Degree, Cert., GED, Other)

GPA/ Class Rank     Major/Minor

________________________________________________________________________________________________________________________________________________

School (include City & State)     Years Completed    Type (Diploma, Degree, Cert., GED, Other)

GPA/ Class Rank     Major/Minor

________________________________________________________________________________________________________________________________________________

References
List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Name Title Relationship to you Telephone Years known

Name Title Relationship to you Telephone Years known

Name Title Relationship to you Telephone Years known

________________________________________________________________________________________________________________________________________________

Applicant Statement

I certify that information I have provided in order to apply for and secure work with this employer is true, complete and correct.

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 accuracy of all information provided by me in this application, resume 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 non-defamatory information, in a lawful manner, in the employment process and all persons, corporations or organizations for furnishing such information to about me.

I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant consideration for employment on any basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 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.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law. This application does nto consitute an agreement or contract for employment for any specific period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.

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 and that federal immigration laws require me to complete an I-9 Form in this regard.

This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disiblity, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my immediate discharge from the employer's service, whenever it is discovered.

Do Not click the submit button until you have read the above applicant statement.

By checking this box you are certifying that you have read, fully understand and accept all terms of the forgoing Applicant Statement.