Application

Position Applying For *

Name *

First

Middle

Last

Social Security Number *

Phone Number *

Email *

Street Address *

City, State, Zip *

Emergency Contact Name

Emergency Contact Phone Number

Expected Wage *

Available Start Date *

Days Available For Employment *

Type of Work *

Part Time
Full Time
Temporary/Short Term
Long Term

Check all that apply

Availability *

Evenings
Nights
Out of Town/Overnight

Check all that apply

I have a dependable vehicle available at all times and can drive myself from job site to job site at any time *

Yes
No

Are you presently 18 years or older *

Yes
No

I am able to legally work in the United States *

Yes
No

Have you been convicted of a crime other than a minor traffic violation or been released from a prison or other detention facility within the past seven years? NOTE: A “Yes” answer does not automatically disqualify you from employment, since the nature of the offense, date and the job for which you are applying will also be considered. If yes, please explain below *

Yes
No

Description (Leave blank if none)

High School; Name and Location *

IE: TVHS, Loveland, CO. (If none, please specify “none”)

*Vocational School; Name and Location *

(If none, please specify “none.” *Transcripts may be requested)

College/University *

IE: Colorado State University, Ft. Collins, CO (if none, please specify “none”)

Other Education (Please Specify)

Please list training, special skills, and work-related experience:

Languages

Employment History 1 – Employer Name *

Employment History 1 – Address *

Employment History 1 – Phone # *

Employment History 1 – Duties/Position *

Employment History 1 – Date Started *

Employment History 1 – Date Left *

Employment History 1 – Reason For Leaving *

Employment History 1 – Starting Salary/Wage *

Specify Hourly or Salary

Employment History 1 – Final Salary/Wage *

Specify Hourly or Salary

Employment History 1 – Name of Supervisor *

Employment History 2 – Employer Name

Employment History 2 – Address

Employment History 2 – Phone #

Employment History 2 – Duties/Position

Employment History 2 – Date Started

Employment History 2 – Date Left

Employment History 2 – Reason For Leaving

Employment History 2 – Starting Salary/Wage

Specify Hourly or Salary

Employment History 2 – Final Salary/Wage

Specify Hourly or Salary

Employment History 2 – Name of Supervisor

Were You Referred To Molecular Coatings? *

Yes
No

Referral Name:

Certificate of Applicant – Read Carefully Before Signing *

First

Last

I hereby state that information given by me in this application is true in all respects. I understand that if I am employed and the information if found to be false in any respect, I will be subject to dismissal without notice at any time. I hereby authorize my former employers to release information pertaining to my work record, my work habits, and my work performance while in their employ. I understand and agree that any employee handbook which I may receive will not constitute an employment contract, but will be merely a gratuitous statement of most of Molecular Coatings, Inc.’s current related policies. I understand that Molecular Coatings, Inc. may require a medical examination to determine if an employee is capable of performing the essential elements of the job. I understand the use of illegal drugs is prohibited during employment with this company and that Molecular Coatings, Inc. reserves the right to test for the presence of illegal drugs at any time. I understand that if the test results are positive for the presence of any illegal drugs, that I will face corrective action up to and including discharge. Molecular Coatings, Inc. can require its employees to submit to blood tests or urinalyses for alcohol or drug screens, fingerprint background checks, credit history checks, inspection of bags (including purses or briefcases) or parcels brought into or taken out of Molecular Coatings, Inc.’s place of business. I understand that refusal to submit to a urinalysis, fingerprint background check, blood test or search, when requested to do so, may result in termination of my employment. I UNDERSTAND AND AGREE THAT IF I AM OFFERED EMPLOYMENT BY MOLECULAR COATINGS, INC., MY EMPLOYMENT WILL BE FOR NO DEFINITE TERM, AND THAT EITHER I, OR MOLECULAR COATINGS, INC.WILL HAVE THE RIGHT TO TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANYTIME, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE. I UNDERSTAND THAT IF I VOLUNTARILY TERMINATE MY EMPLOYMENT WITHOUT NOTICE, SUCH ACTION MAY AFFECT MOLECULAR COATINGS, INC.’, WILLINGNESS TO PROVIDE STATEMENTS OF REFERENCE TO OTHERS CONCERNING MY WORK PERFORMANCE AND HABITS BEYOND A SIMPLE STATEMENT VERIFYING MY EMPLOYMENT. I ALSO UNDERSTAND THAT THIS STATUS CAN ONLY BE ALTERED BY A WRITTEN CONTRACT OF EMPLOYMENT WHICH IS SPECIFIC AS TO ALL MATERIAL TERMS AND IS SIGNED BY ME AND THE ADMINISTRATOR OF MOLECULAR COATINGS, INC

Date *