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TO APPLICANT: We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, veteran status, the presence of non-related medical condition or handicap, or any other legally protected status. Equal access to programs, services and employment is available to all persons. Those applicants requiring accommodation to the application and/or interview process should contact a representative of the personnel department.

Date

Name in Full: * Required

Email Address:

Current Address: Phone: * Required

City: State: County: Zip:

Type of work desired: Wage Expected:

Previously Employed Here?: From: To: Department:

Relatives working at Sabin?: Name: Relationship:

Friends working at Sabin?: Name: Relationship:

Education Name & Location of School Years Attended Course of Study Graduate? Degree(s) Held
Elementary
High School
College
Other

Have you served an apprenticeship? How long? Trade?

Where served? When served?

Mechanical and/or Technical Experience:

Do you have any special qualifications or experience?

Have you ever served in the Armed Forces of the United States?

State rank and branch of service: Date of discharge:

Former Employers: List below all previous employers beginning with your most recent employer. - If you are now working, present employer and reason for seeking a new position must be included. - Also, give reason for lapse of time where a period of termination of one place of employment does not fit into the next place of employement.

Name & Address of Employer Name of supervisor Work performed Date employed from Date employed to Reason for leaving





May we contact the employers listed above? If not, indicate which one you do not wish us to contact:

I agree to wear or use such protective equipment as required by the Company and comply with the safety rules.


Do you agree to read and familiarize yourself with the Employee Handbook, if applicable, you will receive if hired?


NOTE: IT IS UNDERSTOOD THAT FALSE STATEMENTS ON THIS APPLICATION MAY BE CONSIDERED SUFFICIENT CAUSE FOR DISMISSAL. Sabin Metal is an Equal Opportunity Employer. Sabin Metal does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant’s consideration for employment on a basis prohibited by local, State or Federal Law.

I understand that just as I am free to resign at any time, Sabin Metal reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of Sabin has the authority to make any assurances to the contrary.

I understand it is the Company’s policy not to refuse to hire a qualified individual with a disability because of this person’s need for an accommodation that would be required by the ADA.

By checking this box and initialing, you are giving an electronic signature to the above Applicant Initials:

To help the Human Resources department to evaluate and adapt our employment recruitment strategies, we ask you to please complete the following information:

How did you hear about our current job openings? (please check all that apply) Newspaper publications
Job Fair
Department of Labor
Internet
Sabin Metal Referral Name:
Other:

Consent Release

In consideration for employment with Sabin Metal Corporation, I understand and agree that I may, at any time prior to and during employment, be required to submit to drug tests at the request of Sabin Metal Corporation.

If I am employed by Sabin Metal Corporation, physical examinations may be required during my employment.

I authorize the release both verbally and in writing, of all medical test results and information which may be required as a condition of employment with Sabin Metal Corporation, to the Occupational Medicine Program at Strong Memorial Hospital, and to Sabin Metal’s Medical Review Officer.

By checking this box and initialing, you are giving an electronic signature to the above consent release Applicant Initials:

Voluntary Self-Identification Section

The following information is being requested for Government reporting purposes and to measure our good faith outreach efforts. The information that you supple will not be used in our selection decision. Your submission of this information is optional. Failure to provide the information will not be used against you.

Gender:
Race:


Veteran Status

If you believe you belong to any of the categories of protected veterans listed below, please indicate by checking the appropriate box. As a Government Contractor, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake.

Select one:


Protected Veterans are defined by the government as follows:
Disabled Veteran is: (1) a veteran of the U.S. military, ground, naval or air service entitled to compensation (or who but for receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or (2) a person discharged or released from active duty because of a serviceconnected disability.
Recently Separated Veteran means any veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military, group, naval or air service.
Active Duty Wartime or Campaign Badge Veteran means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
Armed Forces Services Medal Veteran means veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Definitions:
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East or North Africa.
Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.
Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, but not limited to, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
American Indian or Native Alaskan (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above six races

Voluntary Self-Identification of Disability

Why are you being asked to complete this section?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier. .

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:
Blindness Deafness Cancer Diabetes Epilepsy Autism Cerebral palsy HIV/AIDS Schizophrenia Muscular dystrophy Bipolar disorder Major depression Multiple sclerosis (MS) Missing limbs or partially missing limbs Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Impairments requiring the use of a wheelchair Intellectual disability (previously called mental retardation)

Select one:



Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.

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