SI Group, Inc. - Application for Employment

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SI Group, Inc.

SI Group, Inc.
P.O. Box 1046
Schenectady, NY 12301
Phone: (518) 347-4274 - Fax: (518) 347-6274
AN EQUAL OPPORTUNITY EMPLOYER
APPLICATION AND QUALIFICATION RECORD
Print a Blank hard copy of this Employment Application. (PDF)

Full Time

Part Time

Summer

Date this form was Completed:

Name:

Last:

First:

Middle:

Present Address (Street, City, State & Zip)

Street:

City:

Area Code & Telephone Number:

State:

Zip Code:

Permanent Address (Only if different from present address):

Street:

City:

Area Code & Telephone Number:

State:

Zip Code:

Email Address:

Are you a US Citizen?

Yes No

If you are not a U.S. Citizen, have you a legal right to remain permanently in the U.S. ? Yes No

Have you ever applied at SI Group Before? Yes No

If Yes, When?

Is your age: Under 18 Over 18

Referred by:

Position / Type of work desired:

Date you can start:

Wages or Salary Expected: $ Hour Week Month Year

Are you presently employed: Yes No

If so, may we contact your current employer: Yes No

Were you ever employed at SI Group? Yes No

If so, when?

Reason for leaving SI Group?

Education:

Highest Grade Completed:

Grade School:	1	2	3	4	5	6	7	8
High School:	9	10	11	12
College:	1	2	3	4
Graduate School:	1	2	3	4

Name:

Location:

Course / Degree

High School:

College:

College / Other:

List any Special Training, Courses Completed or Additional skills:

List your plans, if any, to further your education:

Were you in the Armed Forces? Yes No

If Yes, which branch?

Number of Years in the Service?

Rank at Discharge?

Did you receive an dishonorable discharge? Yes No

* Discharge from the military under other than honorable circumstances is not an automatic bar to employment.

List your duties in the service, including special training and schools:

Have you ever been convicted or pled guilty to a crime? Yes No

If yes, explain fully, listing date, location and type or nature of conviction:

To the best of your knowledge, how many scheduled work days did you miss in the last 12 months?
(Do not include vacation days)

For what reasons?

How many scheduled work days do you normally miss in a 12 month period?

Will you maintain a good attendance record? Yes No

Do you have a reliable means of transportation to get to and from work at SI Group? Yes No

Have you ever been discharged for misconduct or unsatisfactory performance by any previous employer? Yes No

Will you work a rotating schedule that involves work on all three shifts?	Yes No
Will you work on a steady second and/or third shift?	Yes No
Will you work a schedule that regularly includes work on Saturday?	Yes No
Will you work a schedule that regularly includes work on Sunday?	Yes No
Will you work a schedule that involves 12-hour shifts?	Yes No

MANY SI GROUP JOBS REQUIRE THE ABOVE WORK SCHEDULES TO MEET CUSTOMER REQUIREMENTS.

Will you work overtime when requested by a supervisor? Yes No ALL SI GROUP JOBS REQUIRE THIS.

REFERENCES: GIVE BELOW THE NAMES OF FIVE PERSONS (NOT RELATED TO YOU) WHO ARE FAMILIAR WITH YOUR QUALIFICATIONS, SKILLS AND WORK ETHIC/MOTIVATIONS.

	Name	Address	Phone Number	Occupation	Years Acquainted
1.
2.
3.
4.
5.

Are there any relatives currently employed (or previously employed) by SI Group? Yes No

If yes, please name them and their relationship to you:

Employment Record

ACCOUNT FOR ALL PERIODS, including Self-Employment, Unemployment, Military Service, and School. ANSWER COMPLETELY. START WITH PRESENT OR MOST RECENT EMPLOYER. Use Additional Sheet if Necessary.

Name of Employer:	Location of Employer:
Start Date (Month/Year):	Leaving Date (Month/Year):
Your Job Title:	Final/Current Pay: $
Reason for Leaving:	Supervisor's Name/Title:
Description of Your Work and Responsibilities:

Name of Employer:	Location of Employer:
Start Date (Month/Year):	Leaving Date (Month/Year):
Your Job Title:	Final/Current Pay: $
Reason for Leaving:	Supervisor's Name/Title:
Description of Your Work and Responsibilities:

Name of Employer:	Location of Employer:
Start Date (Month/Year):	Leaving Date (Month/Year):
Your Job Title:	Final/Current Pay: $
Reason for Leaving:	Supervisor's Name/Title:
Description of Your Work and Responsibilities:

Name of Employer:	Location of Employer:
Start Date (Month/Year):	Leaving Date (Month/Year):
Your Job Title:	Final/Current Pay: $
Reason for Leaving:	Supervisor's Name/Title:
Description of Your Work and Responsibilities:

Name of Employer:	Location of Employer:
Start Date (Month/Year):	Leaving Date (Month/Year):
Your Job Title:	Final/Current Pay: $
Reason for Leaving:	Supervisor's Name/Title:
Description of Your Work and Responsibilities:

If applying for office work, please indicate the following:

Personal Computer Experience: Number of Years:

Software programs in which you are proficient:

List other office equipment with which you are familiar and years of experience with each:

The remaining part of this application is for your convenience in furnishing additional information. Please state the reasons why you feel you would make a good SI Group employee. We are interested in any jobs, special training or work experience you have had. List any outstanding achievements even though not directly related to the position for which you are applying.

IMPORTANT INFORMATION FOR THE APPLICANT - PRE-EMPLOYMENT STATEMENT AND CONDITIONS OF EMPLOYMENT - READ CAREFULLY BEFORE SIGNING. It is the policy of SI Group, Inc. to provide employment, training, compensation, promotion and other conditions of employment based on qualifications, merit, and business needs without regard to race, color, creed, religion, national origin, sex, age, marital status, military status, sexual orientation, disability, or arrest record and any other basis protected by applicable law.

IN CONSIDERATION FOR RIGHTS AND PRIVILEDGES OF EMPLOYMENT WITH SI GROUP, INC., I HEREBY AGREE TO ABIDE BY COMPANY RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AT SI GROUP IS TERMINABLE AT WILL OF EITHER MYSELF AS THE EMPLOYEE OR SI GROUP AS MY EMPLOYER, UNLESS COVERED BY THE CONDITIONS OF THE COLLECTIVE BARGAINING AGREEMENT, AT ANYTIME FOR ANY REASON. I UNDERSTAND THAT NEITHER THIS APPLICATION, ANY STATEMENTS MADE BY ANY SI GROUP REPRESENTATIVES, NOR ANY OFFER OF EMPLOYMENT FROM SI GROUP CONSTITUTES AN EMPLOYMENT CONTRACT. I ALSO UNDERSTAND THAT NO REPRESENTATIVE OF SI GROUP HAS THE AUTHORITY TO ENTER INTO AN EMPLOYMENT CONTRACT, GUARANTEE EMPLOYMENT FOR A SPECIFIED PERIOD, OR MODIFY ANY OF THE FOREGOING, OTHER THAN IN A WRITTEN DOCUMENT SIGNED BY THE HUMAN RESOURCES DEPARTMENT. I HEREBY AUTHORIZE SI GROUP TO CONDUCT WHATEVER INVESTIGATION NECESSARY IN CONNECTION WITH THE DATA GIVEN HEREIN.

I HOLD FREE FROM LIABILITY ALL FORMER EMPLOYERS OR OTHER PERSONS WHO MAY, IN RESPONSE TO INQUIRIES MADE BY SI GROUP, FURNISH TRUE INFORMATION PERTAINING TO MY EDUCATION, EMPLOYMENT, PERFORMANCE, QUALIFICATIONS AND SKILLS. I ALSO HOLD SI GROUP AND SI GROUP EMPLOYEES FREE FROM LIABILITY IN THE USE OF SUCH DATA.

I CONSENT TO TAKING THE PRE-PLACEMENT MEDICAL EXAMINATION WHICH INCLUDES SUBSTANCE ABUSE TESTING AND SUCH FUTURE MEDICAL EXAMINATIONS AND SUBSTANCE ABUSE TESTING AS MAY BE REQUIRED BY SI GROUP. I Acknowledge That The Unauthorized Use of Alcohol And/Or Drugs Or The Use Of Illegal Drugs Is In Violation Of The Company's Policy And That I Am Subject To Disciplinary Action Up To And Including Discharge For Violation Of This Policy. I Agree In Submitting To This Medical/Physical/Substance Abuse Testing, That The Testing Agency Is Authorized By Me To Provide The Results Of This Test To The Company. I Further Agree To Hold The Company, Its Agents, Directors, Officers And Employees Harmless From Any And All Liability In Connection With The Testing For Drug And/Or Alcohol Content.

I Consent To Signing And Abiding By A Confidentiality Agreement And/Or Invention Assignment Agreement And Such Future Confidentiality Agreements And/Or Invention Assignment Agreements As May Be Required by SI Group.

I Understand That Providing False, Incomplete, Or Misleading Information On This Application, During The Interview, Or At Any Time, Is Cause For Denial Or Termination Of Employment, Regardless Of The Timing Or Circumstances Of Discovery. I Further Agree That If It Is found That I Have Falsified In this Application And Qualification Record, Such Falsification Shall Be Construed To Be Fraud Against The Company, And Shall Be Sufficient Grounds For Permanent exclusion From The Company Premises And For Dismissal If I Shall Be An Employee Of The Company.

Date:

Signature: