In-Pact

APPLICATION FOR EMPLOYMENT

Applicants for employment shall be considered on the basis of their qualifications without regard to race, religion, gender, national origin, age or disability in accordance with State and Federal Equal Opportunity Employment provisions. In the event that a person with a disability is employed at In-Pact, reasonable accommodation in compliance with the Americans with Disabilities Act will be provided.

General Information

Name:
Address:
 
Telephone:
Email Address:
Driver's License Number: State of Issue:

Served in Armed Forces: Branch:
Date of Discharge: Type of Discharge:

Have you ever been convicted of a felony?  

Please indicate what area(s) you are willing to work in:
  Valparaiso Crown Point Merrillville
  Hobart Hammond Dyer

Please indicate what shifts(s) you are available to work:
  Days Evenings Overnights Any

Do you have a valid driver's license and good driving record?  

 

In-Pact

APPLICATION FOR EMPLOYMENT

 

Educational Background

High School Name:
 
High School Address:
Diploma / GED:  

College Name:
 
College Address:
Degree:  
Major:
 
Other Education:


Work History
List work, military or volunteering experience below. Specify the 3 (three) most recent positions.

Employer Name:
Address:
 
Position:
Date of Employment:

 

In-Pact

APPLICATION FOR EMPLOYMENT

 
Employer Name:
Address:
 
Position:
Date of Employment:


Employer Name:
Address:
 
Position:
Date of Employment:



General Information to Applicant

Acceptance of employment by In-Pact, Inc. is an acceptance of the policies and regulations of the In-Pact Board of Directors and regulations set forth by the State of Indiana.


Statement of Applicant

The information contained in this application is true to the best of my knowledge and belief. I hereby authorize the State of Indiana or states/counties within I have resided, any individual, company or institution with who I have associated to furnish In-Pact, Inc. with any information concerning my employment or personal background.


By typing your initials here you confirm that you agree with the statements above.   12/15/2018
Signature   Date