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TO THE APPLICANT: This Employment Application form must be completed in full and signed before it will receive consideration for future employment with Ginsey Industries, Inc. Applications are retained in an active file for a total of 6 months. Should you wish to receive employment consideration after that period of time it will be necessary for you to complete a new application form. You may attach a resume to this completed form.

Ginsey Industries, Inc. is an equal employment opportunity employer, and as such, it is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classification.

Application Information:

(A conviction will not automatically disqualify you for a particular job. The type and seriousness of the crime, the frequency of violations and the date of the conviction will all be considered, along with your entire work and education history.)

Employment-Related Information:

Education and Training:

Former Employment:

(List your last three employers, starting with your present or most recent employer.)

Employer 1 (current):

Employer 2:

Employer 3:


Give names, addresses and telephone numbers of three references (not relatives or former employers.)

Reference 1:

Reference 2:

Reference 3:

I acknowledge that the information I have provided is true to the best of my knowledge, and I authorize investigation of this information as may be necessary. Any misrepresentation or falsification of information, or significant omission, will be cause for rejection of my application, or for subsequent discipline up to and including termination of employment if discovered at a later date.

I understand that I will be required to submit to a pre-employment drug screening analysis. The results of such analysis may be grounds for disqualifying me or terminating my employment.

If employed, I understand that I will be an employee “at will” and that either Ginsey Industries, Inc. or I may terminate my employment relationship at any time, with or without cause, for any reason that does not violate the law.