UBR – Universal Belting Resource (800) 928-9995
Universal Belting Resource

Job Application


We are an equal opportunity employer and will not discriminate on any legally recognized basis, including, but not limited to race, age, color, religion, sex, national origin, citizenship, ancestry, physical or mental disability, veteran status or any other basis recognized by federal, state or local law.


Personal Background:


 First Name: 
 Middle Name: 
 Last Name: 

 Present Address: 
 City: 

 State: 
 Zip: 

 Phone: 

 Referred By: 

 Date you can start?   Desired pay rate: 

 Position Desired:  Part Time Full Time

 Is there any reason we many not inquire of your present employer or past employers? If so, Please explain: 

 Have you ever applied to UBR before? Yes No If YES, specify when?: 
 Are you willing to work overtime? Yes No
 Are you willing to work shifts? Yes No
 If driving is a requirement of the job for which you are applying, do you have a valid driver's license? Yes No

 List the names and relationships of any relatives working for us: 

 If you are a minor, can you produce the work certificate necessary to obtain employment? Yes No

 Are you able, at this time of employment, to submit verification of your legal right to work in the US? (Verification and completion of the Form I-9 must be submitted no later than three Business days after day of hire)? Yes No

 Have you ever been convicted of a felony which is substantially related to the functions or qualifications of the position(s) for which you are applying? Note: This question does not apply to convictions which have been expunged, sealed, pardoned or otherwise exonerated or eradicated. (A conviction record will not necessarily be a bar to employment). ? Yes No

Educational Background:
 High School Graduate? Yes No  High School Name, City & State: 
 College Graduate? Yes No  College Name, City & State: 
 Trade, business or Graduate school: 
 Degree / Main Course of Study: 



Employment History:
 Most Recent Employer



 Company Name:   

  Phone: 

 Address: 

 City:   State:   Zip: 

 From Month/Year  To Month/Year 
 Hourly Rate Start  Hourly Rate End 

 Job Title: 

 Supervisor Name: 

 Briefly Describe your job duties
 


 Other Employer #1



 Company Name:   

 Phone: 

 Address: 

 City:   State:   Zip: 

 From Month/Year  To Month/Year 
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 Job Title: 

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 Briefly Describe your job duties
 


 Other Employer #2



 Company Name:   

 Phone: 

 Address: 

 City:   State:   Zip: 

 From Month/Year  To Month/Year 
 Hourly Rate Start  Hourly Rate End 

 Job Title: 

 Supervisor Name: 

 Briefly Describe your job duties
 



Personal References:

 Reference #1


 First Name:   Last Name: 

 Company:   Phone: 



 Reference #2


 First Name:   Last Name: 

 Company:   Phone: 



 Reference #3


 First Name:   Last Name: 

 Company:   Phone: 



List any specialized Technical Skills (e.g. computer programming/language software, equipment operations, special tools or machines):
 




APPLICANT CERTIFICATION – PLEASE READ CAREFULLY:

I understand that this application is NOT a contract, offer or promise of employment. I acknowledge that employment with UBR is on an employment at will basis. This means that my employment with UBR can be terminated at any time, with or without cause or advance notice and acceptance of employment is NOT a contract of employment for any specified time. Similarly I am free to terminate my employment with UBR at any time for any reason. This at-will provision may be modified or waived only in a written agreement signed by the UBR's president and me.

I further understand that I am responsible for being familiar with UBR's policies, rules and regulations, and I understand that UBR has complete discretion to modify its policies, rules, regulations and practices at any time, to the extent permitted by federal, state and local law, except that it will not modify its policy of employment at will. By my continued employment with UBR, I consent to any such changes.

I certify that the above information is complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation or omission of information on this form or relating to my application of employment may result in my denial of employment, or if employed, my immediate dismissal.

I hereby authorize UBR or its agents to confirm all statements contained in this application and/or resume to the extent permitted by federal, state or local law and I agree to complete any requisite authorization forms*. I release all parties from any liability arising out of this provision and the use of such information.

*Federal law requires a separate release form when obtaining Consumer Credit Reports.


I certify that this information I submit on this form is correct and true:

 YES, I agree * Required




 
* Please verify all fields are fully completed before submitting form