Contact Information - Gammex Inc：联系信息-林丹公司.doc

Application for Employment(An Equal Opportunity Employer)7600 Discovery Drive.Middleton, WI 53562Please fill out the form below to be considered for the position. Fields with an asterisk (*) are required.Contact Information Position: Click here to enter text.*Full Name: Click here to enter text.*Address 1:Click here to enter text.Address 2:Click here to enter text.*City: Click here to enter text.*State: Click here to enter text.*Zip: Click here to enter text.Phone: Click here to enter text.Email: Click here to enter text.Application for Employment PERSONAL INFORMATION*Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):Yes No *Are you at least 18 years or older? (If no, you may be required to provide authorization to work):Yes No *Have you ever been convicted of a felony or a misdemeanor which resulted in imprisonment within the last seven years? (A conviction will not necessarily result in the denial of employment):Yes No If yes, please explain: Click here to enter text.*Have you ever worked for this Company before? : Yes No If Yes, please provide details (Where/When/Job Title): Click here to enter text.*Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation? :Yes No If no, please explain: Click here to enter text. EMPLOYMENT DESIRED*When would you be available to begin work? : Click here to enter text.*Hourly rate/salary desired:Click here to enter text.*Are you currently employed?:Yes No *If so, may we contact your employer?:Yes No If presently employed, why are you considering leaving?:Click here to enter text.EDUCATIONSchool Name & LocationDid you Graduate?Degree ReceivedClick here to enter text.Yes No Click here to enter text.Click here to enter text.Yes No Click here to enter text.Click here to enter text.Yes No Click here to enter text.Click here to enter text.Yes No Click here to enter text.If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:Click here to enter text.SKILLSPlease list any special skills that you have which you feel would be related to the position applied for.Click here to enter text.EMPLOYMENT HISTORY*Give you full employment record, starting with your current or most recent employmentEMPLOYER 1Dates EmployedEmployer Name & AddressEmployer PhoneTo: Click here to enter text.Name: Click here to enter text.Click here to enter text.From: Click here to enter text.Address: Click here to enter text.Job titleSupervisor Name & TitleMay we Contact?Click here to enter text.Name: Click here to enter text.Yes Title: Click here to enter text.No ResponsibilitiesReason for LeavingSalary/Hourly RateClick here to enter text.Click here to enter text.Start: Click here to enter text.End: Click here to enter text.EMPLOYER 2Dates EmployedEmployer Name & AddressEmployer PhoneTo: Click here to enter text.Name: Click here to enter text.Click here to enter text.From: Click here to enter text.Address: Click here to enter text.Job titleSupervisor Name & TitleMay we Contact?Click here to enter text.Name: Click here to enter text.Yes Title: Click here to enter text.No ResponsibilitiesReason for LeavingSalary/Hourly RateClick here to enter text.Click here to enter text.Start: Click here to enter text.End: Click here to enter text.EMPLOYER 3Dates EmployedEmployer Name & AddressEmployer PhoneTo: Click here to enter text.Name: Click here to enter text.Click here to enter text.From: Click here to enter text.Address: Click here to enter text.Job titleSupervisor Name & TitleMay we Contact?Click here to enter text.Name: Click here to enter text.Yes Title: Click here to enter text.No ResponsibilitiesReason for LeavingSalary/Hourly RateClick here to enter text.Click here to enter text.Start: Click here to enter text.End: Click here to enter text.AUTHORIZATIONThe facts set forth in this application and any supplemental information is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same.I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the company to hire me. If I am hired, I understand that either the company or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that