Dico Products Corporation :: NYALOX, PROFLEX, FLEXSHAFT, BUFFING, POLISHING, FINISHING, METAL, SANDING, SANDPAPER, GRINDER, COMPOUNDS, DO-IT YOURSELF.

E M P L O Y M E N T

Dico Products Corporation Application

All potential employees are evaluated without regard to race, color, religion, gender, national origin, age, marital or veteran status, the presence of a non-job related handiacap or any other legally protected status.

Position Sought:

Last Name:

First Name:

Middle Initial:

Address:

Street

City

State

Zip

Home Phone:

Office Phone:

Other Phone:

Email Address:
On what Date would you be available for work?
Desired Wage / Salary $

Are you authorized to work in the U.S. without any restriction	Yes	No
Have you ever been convicted of a felony?	Yes	No
If yes please describe circumstances:
Have you ever been involuntarily terminated or asked to resign from any position of employment?	Yes	No
If yes please describe circumstances:
If selected for employment, are you willing to submit to a pre-employment drug screening test?	Yes	No
Are you willing to travel?	Yes	No
Are you willing to work overtime?	Yes	No

Education

School Name	Location	Years Attendended	Degree Received	Major

Other Training, certifications, or licensese held:

List other information pertinent to the employment you are seeking:

Employment: (Most Recent First)

Employer:		Job Title:
Dates Employed:
Prior Postions Held within company (if any):
Address:
City State and Zip:
Phone:
Supervisor:		Supervisor's Title:
Starting Salary:		Ending Salary:
Duties

Reasons for Leaving

Employer:		Job Title:
Dates Employed:
Prior Postions Held within company (if any):
Address:
City State and Zip:
Phone:
Supervisor:		Supervisor's Title:
Starting Salary:		Ending Salary:
Duties

Reasons for Leaving

Employer:		Job Title:
Dates Employed:
Prior Postions Held within company (if any):
Address:
City State and Zip:
Phone:
Supervisor:		Supervisor's Title:
Starting Salary:		Ending Salary:
Duties

Reasons for Leaving

References - Give the names of three persons not related to you, whom you have known at least one year.

Name	Address	Business	Years Acquainted

Additional Information

Applicant's Certfication and Agreement

I hereby certify that the facts set forth in the above
employment application are true and complete to the best of
my knowledge and authorize Divine Brothers Company to verify
their accuracy and to obtain reference information on my work
performance, character, general reputation and personal
characteristics. I hereby release Dico Products Corporation from
any/all liability of whatever kind and nature which, at any
time, could result from obtaining and having an employment
decision based on such information. You have the right to make
a written request within a reasonable period of time to receive
additional detailed information about the nature and scope of
this investigation.
I understand that, if employed, falsified statements of any kind
or omissions of facts called for on this application shall be
considered sufficient basis for dismissal.
I understand that should an employment offer be extended to
me and accepted that I will fully adhere to the policies, rules
and regulations of employment of the Employer. However, I
further understand that neither the policies, rules, regulations
of employment or anything said during the interview process
shall be deemed to constitute the terms of an implied
employment contract. I understand that any employment
offered is for an indefinite duration and at will and that either I
or the Employer may terminate my employment at any time
with or without notice or cause.