The Zinc Die Casting Leader!
BRILLCAST MANUFACTURING LLC
GRAND RAPIDS, MI | MON-FRI 8AM-5PM (EST)
Manufacturers of the Highest Quality
Zinc Die Casting Components


Brillcast Application for Employment - An Equal Employment Opportunity Employer

Apply NowINSTRUCTIONS
Although this application may be given consideration, its receipt does not imply that there are open positions or that the applicant will be employed. Brillcast reserves its right to withdraw any offer of employment at any time; similarly, the applicant has the right to withdraw this application at any time. If you wish to submit a resume, you may attach it to this application, but in addition, you must complete this application and answer all questions, even those which relate to information on your resume. Please be sure that all of your answers on this application are complete, correct, and truthful. You should understand that any omission of relevant information, any false or misleading statement, or any failure to disclose facts which, if known, might reflect unfavorably on this application, may result in dismissal even if you are employed.

Please answer every question. You will not be considered as a candidate for a job with us until we have received this application fully completed and signed by you. As required by law, Brillcast does not discriminate in hiring or employment on the basis of race, color, religion, national origin, non-disqualifying disability, sex, age, height, weight, or other legally protected characteristic.

*Required fields to submit form

Apply for a job at brillcast online!SECTION 1 - Contact Information

Today's Date*
Current Emal Address*


PRINT YOUR NAME AS IT APPEARS ON YOUR SOCIAL SECURITY CARD

First Name*
Middle Name*
Last Name*

Address*
City*
State*
Zip*

Length of Time at This Address*
Telephone*
Daytime Telephone (If Different)

List previous addresses within the United States, except military, if your address changed during the past 5 years. (Start with most recent address.)

Address
City
State
Zip
From (Date) To (Date)

Address
City
State
Zip
From (Date) To (Date)


SECTION 2 - Employment Request

Type of work desired*


Specify position(s) for which you are applying

Position 1*
Position 2

Salary Requirements*

Per Hour Per Week Per Year

Kind of Work Sought*
Part Time Full Time

If you would be available for part-time work, please list the days of the week and hours you would be available:



What shifts are you available to work?*
Any Shift Not 1st Shift Not 2nd Shift Not 3rd Shift

How were you referred to us?*
Date available for work*

If you applied in response to an advertisement, where did you see the ad?


Have you applied with us previously?*
Yes No
If yes, when and where?


List everyone you know who works for us


Are you able to do the essential functions of the job(s) for which you are applying?*
Yes No

If no, please identify the applicable functions



SECTION 3 - Employment History

ATTENDANCE RECORD
How much time have you lost from work or school during each of the past two calendar years FOR REASONS OTHER THAN VACATION AND HOLIDAYS?

Year*
Number of Days*
Year*
Number of Days*

Do you have any activities, commitments, or responsibilities (for example car pooling, school, other employment) which might in any way restrict the hours (including overtime) or days you can work?*
Yes No

Explain if Yes


Are you presently employed?*
Yes No

May we contact your present employer to obtain a reference?*
Yes No

Starting with PRESENT or MOST RECENT, list all previous employers. Include self-employment, summer, and part-time jobs. Account for periods of unemployment of more than 30 consecutive days by listing "unemployed" under EMPLOYER, and state beginning and ending dates of unemployment.

EMPLOYER 1

Employer (Present or Most Recent)
Supervisor
Department
Telephone

Date Started
Pay at Start
Date Left
Pay at Leaving

Reason for leaving


Your job and responsibilities (Please be specific; describe in detail)


EMPLOYER 2

Employer (Present or Most Recent)
Supervisor
Department
Telephone

Date Started
Pay at Start
Date Left
Pay at Leaving

Reason for leaving


Your job and responsibilities (Please be specific; describe in detail)


EMPLOYER 3

Employer (Present or Most Recent)

Supervisor
Department
Telephone

Date Started
Pay at Start
Date Left
Pay at Leaving

Reason for leaving


Your job and responsibilities (Please be specific; describe in detail)


SECTION 4 - Education

High School(s)

Name of School
City & State
Course/Major
Last Grade Completed
9 10 11 12
Degree Received
Diploma GED None

Name of School
City & State
Course/Major
Last Grade Completed
9 10 11 12
Degree Received
Diploma GED None

College(s)

Name of School
City & State
Course/Major
Number of Years Completed
1 2 3 4
Did you receive a degree?
Yes No

Name of School
City & State
Course/Major
Number of Years Completed
1 2 3 4
Did you receive a degree?
Yes No

Graduate Studies

Name of School
City & State
Course/Major
Number of Years Completed
1 2 3 4
Did you receive a degree?
Yes No

Other - Give Type

Name of School
City & State
Course/Major
Number of Years Completed
1 2 3 4
Did you receive a degree?
Yes No

Vocational or technical courses studied


List any computer software and equipment and other office equipment you can operate proficiently


List any special certification, skills, knowledge, or experience which you feel may be relevant to the job you are seeking

Are you planning to pursue or are you currently enrolled in any studies or courses?*
Yes No

If yes, when, where, for what period of time, or for what courses are you enrolled?


If you are now employed, why do you want to change your job?

Have you ever been fired, dismissed, asked to resign, resigned by mutual agreement, or otherwise been terminated from any job?*
Yes No

If yes, what job and why?



SECTION 5 - Personal Information

Are you 18 years of age or older?*
Yes No

Have you ever been convicted of any crime other than a routine traffic offense? (Includes a "no contest" or "guilty" plea)*
Yes No

If yes, explain:


Are you currently under indictment or charged with a felony?*
Yes No

If yes, explain:


Have you ever had an application or surety bond refused?*
Yes No

REFERENCES

Name
Phone Number
Address

Name
Phone Number
Address

Name
Phone Number
Address

Additional Notes or Comments


SECTION 6 - Applicants Certification & Agreement

PLEASE READ CAREFULLY AND SIGN BELOW IF YOU AGREE TO THESE TERMS OF EMPLOYMENT.

1. Certification of Truthfulness: I represent that all my statements in support of my Application for Employment are true and complete. I understand and agree that if Brillcast, at any time, should determine that any requested information was withheld by me or any of my statements are false or misleading, I may be discharged.

2. Employment at Will: If hired by Brillcast, I agree to comply with all rules, regulations, policies, and communications directed to employees, including any changes made from time to time. I understand that I will be free to resign my employment at any time with or without cause, and with or without prior notice or warning to Brillcast; I agree that Brillcast also may terminate my employment at any time, with or without cause and with or without prior review, notice, or warning.

3. Limitation on Claims: I agree that any lawsuit against Brillcast and/or its agents arising out of my employment or termination of employment, including but not limited to claims arising under State or Federal civil rights statutes, must be brought within the following time limits or be forever barred: (a) for lawsuits requiring a Notice of Right to Sue from the EEOC, within 90 days after the EEOC issues that Notice; or (b) for all other lawsuits, within (i) 180 days of the event(s) giving rise to the claim, or (ii) the time limit specified by statute, whichever is shorter. I waive any statute of limitations that exceeds this time limit.

4. Authorization to Work: If I am selected for hire, I will be offered employment provided I certify and produce applicable documentation that I am authorized to work as required by the Immigration Reform and Control Act of 1986.

5. Need For Accommodation: If I, due to a physical or mental disability, require an accommodation to perform the job for which I may be selected, I understand that I must give Brillcast written notice of that need within 182 days after I know or reasonably should have known that an accommodation is needed. Failure to do so may bar me from alleging that Brillcast has not accommodated me as required by law.

6. Drug Testing: I agree to provide Brillcast with appropriate specimens to test for the presence of drugs or other controlled substances. I understand that decisions concerning my employment will be made as a result of these tests.

7. Physical Exam and Release of Medical Information: I understand that any job offer will be conditioned on passing a physical exam. I authorize every medical doctor, physician or other health care provider (HCP) to provide any and all information, including but not limited to medical reports, laboratory reports, X-rays or clinical abstracts relating to my previous health history or employment in connection with any examination, consultation, test or evaluation. I will cooperate in obtaining any additional authorization required by any HCP for release of any information. I hereby release every HCP and every other person, firm, officer, corporation, association, organization or institution which shall comply with the authorization or request made in this respect from any and all liability for disclosure made pursuant to my authorization. I understand that medical information will not be requested from me, my physician or other HCP until a job offer has been made.

8. Disclosures: I agree that the contents of any offices, work spaces, desks, computer and computer generated data, any Brillcast property I may be using, and any of my own property I bring onto Brillcast’s premises, may be inspected by Brillcast at any time it determines there is reasonable cause to do so, and I waive and promise not to make any claims against Brillcast (or its employees or agents) relating to such inspection. I agree that, except as directed otherwise in writing by Brillcast, I will not disclose to anyone or use for my own purposes, any of Brillcast’s confidential or proprietary information, either during or after my employment. I understand and agree that client names and information, financial data, computer information and processes are confidential and proprietary information and I will not make written or other copies or notes regarding these matters except as necessary to perform my job. I agree that if my employment ends, I will deliver to Brillcast all material of any kind that I have relating to its business, including any such copies or notes. I agree that if any of the above commitments by me is ever found to be legally unenforceable as written, the particular agreement concerned shall be limited to allow its enforcement as far as legally possible.

9. Consideration for Employment: I agree to the above terms of employment if I am employed by Brillcast. I understand that my application will be considered pursuant to the Company’s normal procedures for a period of 60 days. If I am still interested in employment thereafter, I must reapply. Should I be employed, I understand and agree that these provisions of my employment can be revised only by a signed contract authorized by a written resolution of Brillcast, and that no person in Brillcast has any authority to offer employment other than on an at-will basis as described above. I understand and agree that, except as provided above, all compensation, benefits, programs, rules, and policies of Brillcast are subject to exception or change at any time as decided by Brillcast in its sole discretion.


I acknowledge by my agreeing to the terms of employment that I have been given adequate time to read, complete, and review my application and this certification, and I have knowingly and voluntarily signed below.

Do you agree with the terms of employment?*
Yes No

Full Name*
Today's Date*

AUTHORIZATION AND WAIVER
This authorization and waiver is part of my written application for employment with Brillcast.

I authorize all employers and educational institutions where I am or have been employed or enrolled, and all law enforcement agencies, to disclose to Brillcast any and all information in their possession about my employment history (including disciplinary and other matters), personal background, and/or credit background. I hereby waive written or other notices from all such parties of their release of any such information to Brillcast. I further authorize all educational institutions I have attended to disclose to Brillcast any and all information in their possession regarding my attendance and performance at such institution, including but not limited to: disclosure of any diploma or degree of certification awarded; disclosure of academic information and transcripts; and disclosure of any disciplinary record. I hereby waive written or other notice from such institution of its release of any such information to Brillcast.

I understand that under Michigan’s Bullard-Plawecki Employee-Right-To-Know Act I am entitled to notice of the release of information from my personnel record, and I hereby specifically waive any such notice from any prior employer.

I release all my prior employers and educational institutions, and all law enforcement agencies, from any liability or claim relating to the release of information, records or opinions to Brillcast, or to any employment decisions made by Brillcast as a result thereof.

For purposes of this Authorization and Waiver, a photocopy of my signature shall have the same force and effect as my original signature.

Do you agree with the authorization and waiver?*
Yes No

Full Name*
Today's Date*

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BRILLCAST MANUFACTURING LLC | 3400 Wentworth Dr SW, Grand Rapids, MI 49519 | TEL: (616) 534-4977 HOURS: Mon-Fri 8am-5pm (EST) | Copyright © 2015 Brillcast Manufacturing LLC