Laboratory Technician - Yuasa Battery, Inc.

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Have You Ever Been Employed By Any Division or Subsidiary of this Company? YesNo

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HAVE YOU APPLIED HERE BEFORE? YesNo

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ARE YOU LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES? YesNo

PROOF OF CITIZENSHIP OR IMIGRATION STATUS PERMITTING EMPLOYMENT WILL BE REQUIRED UPON EMPLOYMENT

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ARE YOU KNOWN TO SCHOOLS/REFERENCES BY ANOTHER NAME? YesNo

IF YES, WHAT NAME?

HAVE YOU EVER BEEN CONVICTED OF A FELONY? YesNo

CONVICTION OF A FELONY WILL NOT AUTOMATICALLY DISQUALIFY YOU FROM CONSIDERATION FOR EMPLOYMENT

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HIGHSCHOOL NAME:

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DIPLOMA:

(1) NAMES AND LOCATIONS OF COLLEGES, TECHNICAL AND OTHER SCHOOLS:

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(2) NAMES AND LOCATIONS OF COLLEGES, TECHNICAL AND OTHER SCHOOLS:

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SPECIAL TRAINING OR SKILLS:

POSITION 1:

LAST OR PRESENT JOB TITLE:

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FROM MONTH:

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LAST OR PRESENT JOB TITLE:

COMPANY NAME:

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SUPERVISOR’S NAME:

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FROM MONTH:

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LAST EARNINGS:

PER YEAR (OR):

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POSITION 3:

LAST OR PRESENT JOB TITLE:

COMPANY NAME:

Address 1:

Address 2:

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Zip:

SUPERVISOR’S NAME:

PHONE:

FROM MONTH:

TO MONTH:

LAST EARNINGS:

PER YEAR (OR):

JOB RESPONSIBILITIES:

REASONS FOR LEAVING:

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Agreement

I certify that my responses to the above are true, and recognize that I shall be subject to immediate dismissal from employment if it is determined that the answers provided by me, herein, are untrue or that I have failed to disclose a material fact.

I understand that my application is not a contract and cannot create a contract. In consideration of my employment I agree to conform to all the rules and regulations set forth by YUASA Battery, Inc. I acknowledge that only written representations and promises, whether made during the interview or employment process, will be honored.

I understand the Company may require, as a condition of employment, biological sample (urine and blood) to determine drug (controlled substance) contamination. I realize that a positive drug test will disqualify me from employment. After a conditional offer of emplouyment has been made, biological sample (urine and blood) to determine blood lead level and a physical examination to determine fitness for a specific position may be required. I further understand that my employmehnt may be subject to various federal and state regulations including the OSHA Lead Standard, and in connection with these regulations.

I understand that the Company may investigate the accuracy of the information I have provided, by means of reference checks of employment and education history. I hereby authorize such investigation, and release from, and hold the Company harmless against any claims or liability arising from such investigation. To further authorize former employers and educational institutions to provide information in response to the Company’s inquiries and release such employers and institutions from liability arising from the provision of such information.

I consent to the conditions.

SUCCESS!

YOUR APPLICATION HAS BEEN SUBMITTED!

Thank you for submitting your application. If you meet our qualifications for the position you applied for, a human resources representative will be reaching out to discuss the next steps in the process. Thank you for considering us in your job search.