Apply Online for Job Openings at Eagle Elastomer

Eagle Careers ApplicationWe are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service-member status, race, color, religion, sex, national origin, age, physical or disability, genetic information or any other category protected by applicable federal, state, or local laws.

Eagle Elastomer Employment Application

Step 1 of 5

Please answer ALL questions. Resumes are NOT a substitute for a completed application.
Today's Date*
MM slash DD slash YYYY
Applicant Name*
First Last
Position Applying For*
Phone*
Is this a mobile phone number?*
- Yes
- No
Alternate Phone (optional)
Is this a mobile phone number?*
- Yes
- No
Email (optional)
Present Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Length of time at your present address*
Years / Months

Type of employment desired*
- Full-time
- Part-time
Specify hours (optional)
Are you willing to work overtime?*
- Yes
- No
Date on which you can start work if hired?*
MM slash DD slash YYYY
Have you previously applied for employment with this company?*
- Yes
- No
If yes, when did you apply?*
MM slash DD slash YYYY
Where did you apply?*
Have you ever been employed by this company?*
- Yes
- No
If yes, when did you start?*
MM slash DD slash YYYY
When did your employment end?*
MM slash DD slash YYYY
Because it may be necessary to allow us to confirm your world and educational record, have you ever had a change of name, used an assumed name, nickname, etc.,?*
- Yes
- No
If yes, please list any other names by which you have been known by and or used.
High School*
Name Address, City, and State Course of Study or Major Graduate? Number of Years Completed Honors Received
Any College?*
- Yes
- No
College (optional)
Name Address, City, and State Course of Study or Major Graduate? Number of Years Completed Honors Received
Any Graduate/Professional?*
- Yes
- No
Graduate/Professional (optional)
Name Address, City, and State Course of Study or Major Graduate? Number of Years Completed Honors Received
Any Trade/Correspondence?*
- Yes
- No
Trade/Correspondence (optional)
Name Address, City, and State Course of Study or Major Graduate? Number of Years Completed Honors Received
Do you have previous work experience?*
- Yes
- No
Please list the names of you present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach additional sheets if needed. If self-employed, supply firm name and business references. You may include any verifiable work performed on a volunteer bases, internships, or military services. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Do not answer, "see resume."
Employer #1 (Current or Most Recent)*
Employer Name Address City, State, and Zip-code Type of Business
Phone*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Details*
Job Title Duties Supervisor's Name
May we contact employer #1?*
- Yes
- No
If No, why not?*
Reason for leaving?*
Where you terminated by employer #1?*
- Yes
- No
If Yes, for what?*
Where you ever disciplined by employer #1?*
- Yes
- No
If Yes, for what?*
Did you give notice to employer #1 when resigning?*
- Yes
- No
If Yes, how much?*
If No, please explain*
Employer #2?*
- Yes
- No
Employer #2*
Employer Name Address City, State, and Zip-code Type of Business
Phone*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Details*
Job Title Duties Supervisor's Name
May we contact employer #2?*
- Yes
- No
If No, why not?*
Reason for leaving?*
Where you terminated by employer #2?*
- Yes
- No
If Yes, for what?*
Where you ever disciplined by employer #2?*
- Yes
- No
If Yes, for what?*
Did you give notice to employer #2 when resigning?*
- Yes
- No
If Yes, how much?*
If No, please explain*
Employer #3?*
- Yes
- No
Employer #3*
Employer Name Address City, State, and Zip-code Type of Business
Phone*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Details*
Job Title Duties Supervisor's Name
May we contact employer #3?*
- Yes
- No
If No, why not?*
Reason for leaving?*
Where you terminated by employer #3?*
- Yes
- No
If Yes, for what?*
Where you ever disciplined by employer #3?*
- Yes
- No
If Yes, for what?*
Did you give notice to employer #3 when resigning?*
- Yes
- No
If Yes, how much?*
If No, please explain*
After you have completed the 3 employer sections in the, "previous work experience" and still need to provide additional work history to show the last 10 years of employment history, please upload the supporting documentation at the end of this application.
Have you ever been terminated or asked to resign from any job?*
- Yes
- No

If Yes, provide the number times and the circumstance of each occasion*

Has your employment ever been terminated by mutual agreement?*
- Yes
- No

If Yes, provide the number times and the circumstance of each occasion*

Have you ever been given the choice to resign rather than be terminated?*
- Yes
- No

If Yes, provide the number times and the circumstance of each occasion*

Work References (optional)
Name Position Company Work Relationship (Supervisor, co-worker, etc.) Phone
Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references.
Personal References (optional)
Name Occupation Address Number of Years Known Phone
Please list the names of personal references (not previous employers or relatives) who you know that we may contact.

Do you have a current valid Driver's License? (optional)
- Yes
- No
Driver's License Information
License Number State of Issue Expiration Date
Complete only if driving is an essential function of the job for which you are applying.
If you do not have a Driver's license for the state in which you currently reside, why not?*
Has you Driver's license ever been suspended or revoked?*
- Yes
- No
If Yes, explain*
Do you have personal automobile insurance?*
- Yes
- No
If No, explain*
Have you ever been denied personal automobile insurance or has it ever been terminated or suspended?*
- Yes
- No
If Yes, explain*

Please list all moving traffic violations in the last five (5) years*

Offense	Date	Location	Comments

APPLICANT CERTIFICATION*
I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver's license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside.
I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such as program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-Offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free work-place, consistent with applicable federal, state and local law. I also understand that all employees of the location, pursuant to the Company's policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company's policies and applicable federal, state, and local law.
If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property.
I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sigh a confidentiality, restrictive covenant, and/or conflict of interest statement.
I certify that all the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, of omission of any information may result in disqualification form consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.
THIS COMPANY IS AN AT-WILL EMPLOYER AS ALLOWED BY APPLICABLE STATE LAW. THIS MEANS THAT REGARDLESS OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OF IN ANY DOCUMENT OR STATEMENT, WRITTEN OF ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OF REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENT - EXPRESS OF IMPLIED - WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE COMPANY. IF HIRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL.
I authorize the Company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking to the extent permitted by federal, state, and local law. I agree to complete any requisite authorization forms for the background investigation which may be permitted by federal, state, and/or local law. If applicable and allowed by law, I will receive separate written notification regarding the Company's intent to obtain "consumer reports."
I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, changes, or cause of action which I may has as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. Further, if hired, I authorize the Company to provide truthful information concerning my employment to future employers and hold the Company harmless for providing such information.
If hired by this Company, I understand that I will required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. I also understand this Company employs only individuals who are legally eligible to work in the United States.
I have read all of the information contained within this application

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, ACCURATE, AND COMPLETE.
DO NOT SIGN UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THE APPLICATION.
Applicant Signature*
First Last
Signature Date*
MM slash DD slash YYYY
Is the applicant a minor? (If the applicant is a minor, the foregoing release and consent must be signed by the applicant's parent or legal guardian.)*
- Yes
- No
If the applicant is a minor, the foregoing release and consent must be signed by the applicant's parent or legal guardian. Signature by the applicant's parent or legal guardian constitutes acknowledgement by the applicant and the parent of legal guardian that the Company, to the extent permitted by federal, state, and local law, can test the applicant for illegal or controlled substances, conduct inspections of property without notice, and communicate test results to Company personnel who need to know, the applicant, and the applicant's legal guardian.
Parent/Legal Guardian Signature*
First Last
Signature Date*
MM slash DD slash YYYY
Witness Signature*
First Last
Signature Date*
MM slash DD slash YYYY
UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR, POLYGRAPH, OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

I have read and understand the above statement.
Applicant Signature*
First Last
Signature Date*
MM slash DD slash YYYY

IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
FOR CALIFORNIA APPLICANTS ONLY: BY CHECKING THIS BOX, I WAIVE MY RIGHT TO RECEIVE A COPY OF ANY PUBLIC RECORD OBTAINED BY THE COMPANY FOR EMPLOYMENT PURPOSES THROUGH AN INTERNAL INVESTIGATION
FOR CALIFORNIA APPLICANTS ONLY: BY CHECKING THIS BOX, I WAIVE MY RIGHT TO RECEIVE A COPY OF ANY PUBLIC RECORD OBTAINED BY THE COMPANY FOR EMPLOYMENT PURPOSES THROUGH AN INTERNAL INVESTIGATION
FEDERAL AND/OR STATE LAW MAY PROHIBIT THE USE OF LIE DETECTOR, POLYGRAPH OR SIMILAR TEST AS WELL.
THIS APPLICATION MAY NOT BE SUFFICIENT FOR ALL INDUSTRIES OR APPROPRIATE FOR USE IN ALL LOCALITIES.
*This employment application is not appropriate for use by Rhode Island employers exempt from the state's Workers' Compensation laws.
Upload Files Here (resume, additional work history, etc.)*
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