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Ultraflex Systems Inc.

Application Form

Ultraflex Systems, Inc. is an equal opportunity employer. Interviewing and hiring practices at Ultraflex Systems, Inc. do not discriminate on the basis of race, color, sex, age, national origin, physical or mental disability or disabled veteran status.

ATTENTION: The privacy of all applicants is extremely important. Therefore, we have taken precautions by implementing SSL encryption on this entire application form.

DO NOT USE "BACK" BUTTON WHEN FILLING OUT APPLICATION (info. will be lost and will have to be re-entered). Please fill out the application as completely as possible.

Note - minimum required fields are in RED. Incomplete applications will not be processed:

First Name:        Last Name:
Driver's License #:
Street Address:
City:
State: Zip:
Day Phone: Evening Phone:
E-Mail Address:
Select Position Applying for from Drop Down Menu: ------------------------>

Select Here
When would you be available for work?
Have you worked for us before? Yes No

Please list any related training or special skills:
(computer, languages, machinery, etc...)

Were you referred by a current/former employee?

If so, who?

Yes No

Do you have any relatives who work here?

If so, who?

Yes No

Are you 18 years or older? Yes No
Are you eligible for work in the United States? Yes No

Have you ever been convicted of a felony?

If yes, please explain:

Yes No

Previous Employment Information
Do you have any prior employment experience? Yes No

If you answered No to the question above, please click here to skip to the next section of the application.

If you answered Yes to the question above, please provide complete and detailed information for each employer. Form will not submit with missing fields.

MOST RECENT
Employer:

Street Address:

City:
State: Zip:
Telephone:
Fax:
Job Title:
Supervisor:
Dates Employed: to
Hourly Rate: to

Reason for leaving:

Work Performed:

May we contact this employer?

Yes No
   
   
SECOND MOST RECENT
Employer:

Street Address:

City:
State: Zip:
Telephone:
Fax:
Job Title:
Supervisor:
Dates Employed: to
Hourly Rate: to

Reason for leaving:

Work Performed:

May we contact this employer?

Yes No
   
   
THIRD MOST RECENT
Employer:

Street Address:

City:
State: Zip:
Telephone:
Fax:
Job Title:
Supervisor:
Dates Employed: to
Hourly Rate: to

Reason for leaving:

Work Performed:

May we contact this employer?

Yes No
   
   
FOURTH MOST RECENT
Employer:

Street Address:

City:
State: Zip:
Telephone:
Fax:
Job Title:
Supervisor:
Dates Employed: to
Hourly Rate: to

Reason for leaving:

Work Performed:

May we contact this employer?

Yes No
   
   

Education Information
High School:
Location:
Course of Study:
Did you graduate? Yes No
Degree/Diploma:
   
College:
Location:
Course of Study:
Did you graduate? Yes No
Degree/Diploma:
   
Graduate School:
Location:
Course of Study:
Did you graduate? Yes No
Degree/Diploma:
   
Vocational Training or Other:
Location:
Course of Study:
Did you graduate? Yes No
Degree/Diploma:
   
Continuing Education:
   
Hobbies/Outside Interests:
References
(2 professional, 1 personal)		  
Name:
Relationship:
Years Known:
Phone:
Address:
   
Name:
Relationship:
Years Known:
Phone:
Address:
   
Name:
Relationship:
Years Known:
Phone:
Address:
Résumé Upload
You may attach a résumé file to this application if you wish. Please be sure this file is a Plaintext file, a Microsoft Word file, or a PDF file format (.txt, .doc, .pdf) for proper submission.

CONSUMER REPORTS NOTIFICATION

You are hereby notified that a consumer report or an investigative consumer report may be obtained from a consumer reporting agency, other agency or directly by this employer for the purpose of evaluating you for employment, promotion, reassignment or retention as an employee.

Reports may include consumer credit, criminal convictions, motor vehicle and other reports. These reports may include information as to character, work habits, performance, education and experience along with reasons for termination of employment from previous employers. Further understand that we may be requesting information from various Federal, State and other agencies which maintain records concerning your past activities relating to your driving, credit, criminal, civil and other experiences.

DISCLOSURE AND AUTHORIZATION REGARDING PROCUREMENT OF BACKGROUND REPORTS

In connection with my application for employment (including contract for services), I understand that investigative background inquiries are to be made on me which may include consumer credit, criminal convictions, motor vehicle, and other reports. These reports may include information as to my character, work habits, performance, education and experience along with reasons for termination of employment from previous employers. Further, I understand that you may be requesting criminal and civil information from various Federal, State and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil and other experiences.

You have the right to (1) have a copy of this notice provided to you on paper or in non-electronic form and, if hired, (2) withdraw this consent and request paper or non-electronic forms be provided to you. If hired, you must provide such withdrawal of consent, in writing and submit such request in writing to the Resource Allocation Management Team Leader. You should print and retain a copy of this Disclosure and Authorization for your records. You may also request a written copy from the Resource Allocation Management Team Leader, Ultraflex Systems, Inc., 534 Trestle Place, Downingtown, PA 19335-3459

I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from any liability and responsibility for doing so. I hereby consent to obtaining the above information from VeriCORP, Inc. and /or any of their licensed agents. This authorization and consent shall be valid in original, fax, electronic or copy format, in accordance with federal law. I further authorize ongoing procurement of the above mentioned reports at any time during my employment (or contract) and have received a copy of the Consumer Reports Notification regarding pulling of such consumer reports.

I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to Ultraflex Systems' procedures, rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or Ultraflex Systems' option. I also understand and agree that the terms and condition of my employment may be changed, with or without cause and with or without notice, at any time by Ultraflex Systems, Inc.. I understand that no Ultraflex Systems representative, other than it's team leaders or president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

Please digitally sign: Date: (just type your initials/date in the text boxes - this is a legally binding signature)

                    
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©2010 UltraflexSystems.Inc., U.S. and International Patents Pending 237 South Street Pottstown Pa 19464 1-800-220-6670