Moly Manufacturing, Inc.
2435 Tenth Road
Lorraine, KS 67459
785-472-3388 785-472-2530 (Fax)
www.molymfg.com

This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin, the presence of disabilities, or any other federal or state protected class. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you may be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Phone *

Cell Phone *

Email Address *

Referred By *

Have you ever applied for employment with us?
If Yes, Month and Year *

No

Yes Yes

Are you 18 years of age or older? *

No

Yes

Are you legally authorized to work in the United States? *

Yes

No

For which position are you applying? (Examples: Welder, Painter, Assembly, Engineering, Accounting, Forklift Driver, Administration, CDL Truck Driver, Purchasing, Data Management) *

What date are you available to start? *

What category would you prefer? *

Full-time

Part-time

Temporary

Are you employed now? *

No

Yes

If Yes, may we contact your current employer? *

Yes

No

Have you ever been convicted of, or served time for a felony in the past seven years? *

Yes

No

If yes, please explain.

List languages in which you are fluent.

Type of Driver's License

State that Issued Your Driver's License

Have you had any moving violations in the past 7 years? If Yes, please describe. *

No

Yes Yes

Highest Level of Education Completed *

Please list any other skills, licenses, or certificates that may be job-related or that you feel would be of value to this job or company. *

Are you concerned about having reliable and consistent transportation to and from work? *

Yes

No