Online Application Application for Employment - Updated 5/24 Applicant InformationDate:* MM slash DD slash YYYY Name:* First Last Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone:*Are you 18 years or older? Yes No Date available: MM slash DD slash YYYY Desired Salary: Position applied for: Shift preference: Emergency Contact: Are you a citizen of the United States? Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company before? Yes No If yes, when? EducationHigh School: Location: Did you graduate? Yes No Degree: College: Location: Did you graduate? Yes No Degree: Other: Location: Did you graduate? Yes No Degree: ReferencesPlease list three professional references.Full Name: First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneRelationship: Full Name: First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneRelationship: Full Name: First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneRelationship: GeneralSubjects of Special Study or Research: Special Skills: Activities:(Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members.)U.S. Military or Naval Service: Rank: Present Membership in National Guard or Reserves: Previous EmploymentCompany: Phone:Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name: First Last Job Title: Responsibilities:From: MM slash DD slash YYYY To: MM slash DD slash YYYY Reason for leaving: May we contact your previous supervisor for a reference? Yes No Company: Phone:Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name: First Last Job Title: Responsibilities:From: MM slash DD slash YYYY To: MM slash DD slash YYYY Reason for leaving: May we contact your previous supervisor for a reference? Yes No Company: Phone:Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Name: First Last Job Title: Responsibilities:From: MM slash DD slash YYYY To: MM slash DD slash YYYY Reason for leaving: May we contact your previous supervisor for a reference? Yes No Which of these jobs did you like best? What did you like about this job?Upload ResumeMax. file size: 200 MB.Signature and DisclaimerBy submitting this application online and clicking submit - I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Please type name and date below as signature verification.Signature:* Date* MM slash DD slash YYYY Applicant's AcknowledgementI certify that the answers given herein are true and complete to the best of my knowledge. I understand any misrepresentations, omissions of facts or incomplete answers in any application document may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentation or omissions of facts in any application document may be cause for my dismissal at any time without prior notice. I consent and authorize GVL Poly. to contact my former employers, references and any other persons and organizations for information bearing my qualifications for employment. I further authorize the listed employers, schools and personal references to give GVL Poly any and all information about my previous employment, education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party(ies) for providing good faith reference. I expressly agree and understand that, if employed, my employment is not for a specific term, is based on mutual consent and may be terminated by me or the company with or without notice or cause at any time. I further understand that no oral promise, employer policy, custom, business practice or other procedure (including the Basic Employment Policies, Employee Handbook or any other Personnel Manuals) constitutes an employment contract or modification of the At-Will employment relationship between me and GVL Poly. I also understand that this aspect of my employment with GVL Poly may only be altered with a written authorization signed by the CEO of GVL Poly, and that my At-Will status with ADP TotalSource may not be altered. I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take a pre-employment test; take a driver’s examination; submit to a background investigation or take a pre-employment drug test. If I am offered employment or start work before and required test is completed, my employment is contingent on satisfactory results an all required tests. I authorize GVL Poly to release the results of background checks (if any) and my pre-employment drug/alcohol test (if any), any information on this application and any relevant information about me to each other and to other ADP TotalSource clients for whom I have applied for employment, and release GVL Poly, ADP TotalSource and its clients from any and all claims related to the unlawful release of this information. I further authorize the release of any background check results and of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document. Signature* Date* MM slash DD slash YYYY CaptchaCommentsThis field is for validation purposes and should be left unchanged. Δ