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Hemm's Glass

Glass Shop Piqua Ohio

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Home
About Us
Our Work
Careers
- Career Opportunities
- Apply Online
Locations
Contact Us

Application Form

Online Application

R.C. Hemm’s Glass considers all applicants based upon personal capabilities and qualifications without regard to race, color, religion, sex, age, national origin, disability, veteran status or any other protected characteristic as established by law.
Section A: Personal Information
Complete all applicable information
Position Applying For*
Name*
First Middle Last
Address*
Address Strett City State ZIP
Telephone Number (Primary)*
Telephone Number (Secondary)
Email
Section B: General
Are you interested in:*
- Full-Time
- Part-Time
- Temporary
If offered a position, when are you available to start*
Desired Annual Salary/Wages
How were you referred to us?
- Newspaper
- Radio
- Employment Agency
- Friend/Relative
- Personal Inquiry
Are you legally authorized to work in the United States?*
- Yes
- No
If hired, can you provide proof of your eligibility to work in the United States?*
- Yes
- No
Are you 18 years of age or older?*
- Yes
- No
Have you ever applied for employment with R.C. Hemm’s Glass before?*
- Yes
- No
Provide the date of previous application
Date Format: MM slash DD slash YYYY
Has the company ever employed you before?*
- Yes
- No
Provide the date of previous hire
Date Format: MM slash DD slash YYYY
Are you available to work overtime?*
- Yes
- No
Do you have any friends or relatives working at R.C. Hemm’s Glass?*
- Yes
- No
Who?
Driving Positions Only
Do you have a valid driver’s license?
- Yes
- No
Section C: Education
High School
Name and Location
Course of Study
Years Completed
- 1
- 2
- 3
- 4
Diploma
College
Name and Location
Course of Study
Years Completed
- 1
- 2
- 3
- 4
Diploma/Degree
Graduate School
Name and Location
Course of Study
Years Completed
- 1
- 2
- 3
- 4
Diploma/Degree
Other School
Name and Location
Years Completed
- 1
- 2
- 3
- 4
Course of Study
Diploma/Degree
Second D: Military Service
Were you in the military?
- Yes
- No
What Branch?
Rank at time of discharge
Have you had any job related training in the military?
- Yes
- No
Please describe
Section E: Employment History
List your last three employers, starting with your most recent one first.
Company Name (Most Recent)
Address
Address City State Zip
Supervisor Name
Title of Supervisor
Phone
Last Position
Duties
Start Date
Wage/Salary
Other Compensation
(Bonus/Commission)
Reason for Leaving
Company Name
Address
Address City State Zip
Supervisor Name
Title of Supervisor
Phone
Last Position
Duties
Start Date
Wage/Salary
Other Compensation
(Bonus/Commission)
Reason for Leaving
Company Name
Address
Address City State Zip
Supervisor Name
Title of Supervisor
Phone
Last Position
Duties
Start Date
Wage/Salary
Other Compensation
(Bonus/Commission)
Reason for Leaving
Section F: Personal/Professional References
Do not include family members or past supervisors.
Name (Reference #1)
Phone
Best Time to Call
Occupation
Name (Reference #2)
Phone
Best Time to Call
Occupation
Name (Reference #3)
Phone
Best Time to Call
Occupation
Section G: Explanation of Gaps in Employment
Section H: Computer Programs
Please rank your skill set with the following computer programs
Microsoft Excel*
Microsoft Word*
Please list all other computer programs you have experience with and describe your skill set.
Please describe any training or specialized skills.
Section I: Applicant's Statement
Please read the following statements carefully:
I, the undersigned, understand that I am being considered as a potential employee of R.C. Hemm’s Glass and hereby certify that:
1. In consideration of my employment, I agree to conform to the policies and procedures of the Company. I understand that in accepting this application, R.C. Hemm’s Glass is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered.
2. I understand that if I am hired, such hiring will not be for any definite period of time. Furthermore, I understand, that if I am hired, I will be an employee at-will and I can be terminated at any time, with or without cause and with or without notice.
3. I understand that my status as an at-will employee, and the terms and conditions of that employment cannot be changed except in writing and signed by the President of R.C. Hemm’s Glass.
4. I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any falsified statements on this application or omission of fact on either this application or during the pre-employment process will result in my application being rejected, or, if I am hired, in my employment being terminated.
5. I also understand that any offer of employment is conditioned on the completion of pre-employment tests and documentation. I will, upon request, sign all necessary consent forms.
Signature of Applicant*
Date*
Date Format: MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.