EMPLOYMENT
OPPORTUNITIES

For consideration for one of our positions, please fill out the
following form in its entirety. All information will be confidential.
All applicants will be tested for illegal drugs. Thank you.

EMPLOYMENT APPLICATION
Date
Name
Present address
How long
Telephone
If under 18, please list age
Social sec. no.
Position applied for
Salary desired
Days/hours available to work:
No pref. (check box) Thur.
Mon. Fri.
Tues. Sat.
Wed. Sun.
How many hours can you work weekly?
Can you work nights?
Shift desired
When available for work
Type of school
Name of school
Location
(Complete mailing address)
No. of years
completed
Major & degree
High school
College
Business or trade school
Professional school
Have you ever been convicted of a felony? Yes No
If yes, please explain.
Do you have a driver's license? Yes No
What is your means of transportation to work?
Driver's license number State of issue
Operator Commercial Chauffeur Expiration date
Have you had any accidents during the past three years? Yes No How many?
Have you had any moving violations during the past three years? Yes No How many?
Please list two references other than relatives or previous employers.
Name Name
Position Position
Company Company
Address Address
Telephone Telephone
Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.
Attach resume
MILITARY
Have you ever been in the armed forces? Yes No
Are you now a member of the national guard? Yes No
Specialty Date entered
 Discharge date
WORK EXPERIENCE
Please list your work experience for at least five years, beginning with your most recent job held. If you were self-employed, give firm name.
Name of employer
Name of last supervisor
Employment
dates
Pay or salary
Address
Phone Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer
Name of last supervisor
Employment
dates
Pay or salary
Address
Phone Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer
Name of last supervisor
Employment
dates
Pay or salary
Address
Phone Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer
Name of last supervisor
Employment
dates
Pay or salary
Address
Phone Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer
Name of last supervisor
Employment
dates
Pay or salary
Address
Phone Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer
Name of last supervisor
Employment
dates
Pay or salary
Address
Phone Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact your present employer? Yes No
Did you complete this application yourself? Yes No
If not, who did?
AGREEMENT (PLEASE READ CAREFULLY)
I certify that all the information on this application is accurate and complete to the best of my knowledge and understand that misleading or false statements will constitute sufficient cause for refusal of hire or termination of my employment.

I understand that neither the acceptance of this application nor the subsequent entry into any type of employment relationship with Brunk Industries, Inc. creates an actual or implied contract of employment. I understand that, if I accept employment with Brunk Industries, Inc., it will be on an at-will basis. This means that either Brunk Industries, Inc. or I have the right to terminate the employment relationship at any time, for any reason, with or without cause.

I agree to submit to drug and alcohol testing, if requested by Brunk Industries, Inc.. I release Brunk Industries, Inc., and its employees, plus other persons or companies, from any and all liability arising out of or related in any way to such testing.

I authorize Brunk Industries, Inc. to investigate information concerning my education, employment experiences and all other aspects of my background relevant to my proposed employment. I release Brunk Industries, Inc. and its employees from all liability arising from such investigation.
By selecting this box you agree to the above agreement.
Name: Date:
Brunk Industries, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Brunk Industries, Inc. depends solely on your qualifications.


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BRUNK INDUSTRIES, INC.
1225 Sage Street • Lake Geneva, WI 53147 USA
Phone: (262) 248-8873 • Fax: (262) 248-1057

©2007 Brunk Industries, Inc. All rights reserved.