Job Application

APPLICATION FOR EMPLOYMENT DEFIANCE INTEGRATED TECHNOLOGIES

Answer all questions. If one does not apply, insert N/A. Defiance Integrated Technologies is an Equal Opportunity Employer.

PERSONAL DATA
       
       

EMPLOYMENT INFORMATION
 
Do You Wish to Work: Full TimePart TimeTemporary/Summer OnlyIntern

Indicate which shift(s) you would be available to work: 1st Shift2nd Shift3rd Shift
 
Do you have commitments that might affect your employment with us? yesno

GENERAL INFORMATION

Are you legally authorized to work in the United States:yesno
Are you at least 18 years old? yesno

Will you work overtime if required?yesno

Do you have transportation to and from work? yesno
Will you travel if job requires it? yesno
Will you relocate if job requires it? yesno
Have you previously applied for employment at Defiance Integrated Technologies? yesno

Have you ever been employed by Defiance Integrated Technologies or its subsidiaries? yesno

Answering “yes” to the following question will not automatically disqualify you from being considered as a candidate for employment. Have you ever been convicted of a criminal offense?yesno

EDUCATIONAL DATA
   
Graduatedyesno

     
Graduatedyesno

     
Graduatedyesno

     
Graduated yesno

SKILLS AND QUALIFICATIONS
Summarize any special training, skills, licenses and/or certifications that may assist you in performing the position for which you are applying.
Types of machinery/equipment you can operate:

Computer Skills (Check appropriate boxes. Include software titles and years of experience.)
Word Processingyes 
Presentationyes  
Internetyes  
Spreadsheetyes  
E-Mailyes  
Otheryes  

EMPLOYMENT HISTORY
         
     
May we contact for reference?yesnolater

         
     
May we contact for reference?yesnolater

         
     
May we contact for reference?yesnolater
Explain any gaps in your employment:

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

Affirmative Action: Applicant Invitation to Self-Identify: Gender, Race and Veteran

Defiance Integrated Technologies is an equal opportunity employer. As required by law, we must record certain information to be made a part of our affirmative action program.
Applicants for employment are invited to participate in the affirmative action program by reporting their status as a protected veteran or other minority. In extending this invitation, we advise you that: (a) workers (applicants) are under no obligation to respond but may do so in the future if they choose; (b) responses will remain confidential within the human resource department; and (c) responses will be used only for the necessary information to include in our affirmative action program. We are a company that values diversity. We actively encourage women, minorities, veterans and disabled employees to apply. Refusal to provide this information will have no bearing on your application and will not subject you to any adverse treatment.

Gendermalefemale

Race or Ethnicity (select one) Hispanic or LatinoWhite (not Hispanic or Latino)Black or African American (not Hispanic or Latino)Native Hawaiian or Pacific Islander (not Hispanic or Latino)Asian (not Hispanic or Latino)American Indian or Alaskan Native (not Hispanic or Latino)Two or more races (not Hispanic or Latino)

Veteran Status**I am a protected veteranI am NOT a protected veteranI do not wish to self-identify

How did you hear of our opening? Employee referralCompany websiteSign out frontSocial mediaOther

EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES AND PROTECTED VETERAN DEFINITIONS

*EEOC RACE/ETHNIC IDENTIFICATION CATEGORIES

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
Black or African American (not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
Asian (not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
American Indian or Alaska Native (not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America) and who maintain tribal affiliation or community attachment.
Two or more races (not Hispanic or Latino) - All persons who identify with more than one of the above races.

**PROTECTED VETERAN DEFINITION
Protected veteran means a veteran who may be classified as an active duty wartime or campaign badge veteran, disabled veteran, Armed Forces service medal veteran or recently separated veteran.
Active duty wartime or campaign badge veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces service medal veteran means any veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985 (61 FR 1209, 3 CFR, 1996 Comp., p. 159).
Disabled veteran means (1) a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs, or (2) a person who was discharged or released from active duty because of a service-connected disability.
Recently separated veteran means a veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, ground, naval or air service.

APPLICANT STATEMENT

Please read the following statements carefully

It is the policy of Defiance Integrated Technologies to maintain a safe, healthy and productive work environment for all its employees; to maintain the integrity and security of its facilities and property, and to perform all these functions in a fashion consistent with the interests and concerns of the communities in which it is located. Pursuant to these goals, Defiance Integrated Technologies requires candidates for employment submit to and pass a drug screening test covering illegal substances and legal substances subject to abuse. This requires the candidate to submit to a screening and to sign a release statement provided by the Company or the physician. Refusal or failure to pass such screen will result in the candidate’s disqualification for further employment consideration. I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I understand that my employment can be terminated, with or without cause, at any time at the discretion of either Defiance Integrated Technologies or myself. I understand that no management official has the authority to enter into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment. I authorize persons, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying resume, if any) to provide any relevant information that may be required to arrive at an employment decision. I hereby acknowledge that I have read and understand the foregoing.