Date

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DD

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Date Available to Start: *

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DD

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Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Are you employed now? *

Yes

No

May we contact your current employer? *

Yes

No

Can you work overtime? *

It is not necessary for you to identify unavailability for overtime because of religious observance or practice. After, and if, a conditional job offer is made, we will consider whether reasonable accommodation can be made for your observance.

Yes

No

If the position requires it, are you willing to travel? *

Yes

No

Are you a U.S. citizen or an alien legally authorized to work in the United States? *

Yes

No

Do you have a current driver's license? *

Yes

No

Any driving violations?

Yes

No

Have you ever been convicted of a felony that has not been sealed, expunged or eradicated? *

Yes

No

Within the last five years, have you ever been convicted of, or released from incarceration for a misdemeanor, which was not a first offence for drunkenness, simple assault, speeding, or minor traffic violation, and affray for distributing the peace? *

A criminal conviction will not necessarily be a bar to employment.) To help us evaluate your application, please describe the nature of the crime, when it occurred and your subsequent rehabilitation.

Yes

No

In Massachusetts, a no answer is equivalent to a "No Record" response, and an applicant for employment with a sealed record on file with the Commission of Probation may answer "no record" with respect to any inquiry herein relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. Are you prohibited from or limited in your performance of any job duties for DIXON by restrictive covenant, covenant not to compete, or by a contract of any kind that you signed with any employer? *

If YES, please provide a copy of the agreement to DIXON Inc. for our evaluation.

Yes

No

Did you graduate? *

Diploma

No

GED

Major

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Degree

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Starting Date

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Ending Date

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Starting Date

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Ending Date

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Starting Date

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Ending Date

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Policies & Prodecures *

To the best of my knowledge, information provided by me on this form is true. I understand that if information supplied by me is found to be false or misleading it will be cause for termination or refusal of employment regardless of the time elapsed before discovery. I also understand that any omissions, which prevent DIXON INC from evaluating this application completely, will be cause for refusal of, or termination of employment. I understand that DIXON INC may investigate the information I have provided on this application. I hereby consent to such an investigation and authorize the companies and persons contacted to verify this information. I further authorize past employers and educational institutions provide DIXON INC, those records necessary for consideration of this application. I also understand and agree that DIXON INC can and will rely on information obtained from third parties in connection with my employment. Any employer who violates this statue shall be subject to criminal penal and civil liability. I understand that it is the policy of DIXON INC to hire only acceptable candidates who test free of illegal and unauthorized drugs. Therefore, where permitted by law, I understand that DIXON INC requires me to take a test designed to determine the presence of such drugs in my urine. My signature constitutes my consent to supply my urine for testing and will authorize a testing laboratory designated by DIXON INC to release my test results to those persons involved in the hiring decision or who otherwise have a need to know of such results. I understand that refusal or failure to submit to such testing, falsification of a test, or a positive finding on a test will remove me from consideration for employment. Upon employment, I will be asked to sign agreements setting forth certain terms and conditions of such employment. These agreements include, but are to limited to, a Confidentiality Agreement, a Conflict of Interest Statement, and an Arbitration Agreement. I understand that any offer of employment that I may receive is contingent upon my signing such agreements. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that my employment and compensation may be terminated at any time for any reason or no reason, with or without notice, by DIXON INC or by me. It is further understood that this "at will" employment relationship cannot be changed except in writing by an authorized executive of this organization. If hired, I agree to abide by all of DIXON INC's rules, policies and procedures. I understand that DIXON INC and all plan administrators shall have the maximum discretion permitted by law to administer, interpret, modify, discontinue, enhance or otherwise change all policies, procedures, rules, benefits or other terms or conditions of employment. I understand that if I am offered employment with DIXON INC, no later than three days after commencement of employment, I will be required to present one or more original documents establishing both my identity and authorization to work in the United States or I will be terminated. I also understand that I must verify my identity and authorization to work on the 1-9 Form required by the United States Immigration and Naturalization Service or I will be terminated.

Agree

Disagree