Application for Employment - Progress Industries
Fulfilling needs and pursuing dreams for people with disabilities

Application for Employment

Download the application (download now) and fax back to us, or fill out the application below onli

* denotes a required field.
Personal Information
First Name: *
Last Name: *
Middle Name:  
Address 1: *
Address 2:  
City: *
State: *
Zip Code: *
Home Phone:  
10 digit number only, including area code, no dashes needed.  
Cell Phone:  
10 digit number only, including area code, no dashes needed.  
E-mail:  
Date of Application: * (mm/dd/yyyy)
Pay Expected: *
Position Desired: *
Type of Employment Desired:: *
Full Time Part Time On-Call No Preference
How Did you learn of our Organization?: *
Have you ever been employed by Progress Industries before?:  
Are you legally eligible for employment in the U.S.?: *
If offered a job, when would you be able to start?: * (mm/dd/yyyy)
Are you 18 years of age or older?: *
Do you have relatives working at Progress Industries?: *
If yes, who?:  
Relationship to you?:  
Will you work overtime if asked?: *
What days and times would you be willing to work on a regular basis?: *
Please provide a day of week with the time-frame willing to work.  
Do you have a car?: *
Do you have auto insurance?: *
Have you ever been convicted of a crime in Iowa or any other state, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court.: *
Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.  
If yes, please provide in detail::  
(Criminal convictions are not an absolute ban of employment and will be considered only with respect to the specific requirements of the job for which you are applying)  
Are you currently under investigation by any state licensing board or certifying body, for example the Board of Nursing, or have you ever had your professional license suspended or revoked?: *
If yes, please provide in detail::  
In accordance with federal law, it is the policy of Progress Industries not to employ any individual who is excluded from participation in governmental health care programs.
Are you now, or have you ever been, excluded from participation in governmental health care programs?: *
If yes, please provide in detail::  
Proof Of Citizenship: *
Education
High School:  
Name and Location of High School  
Number of Years Completed:  
Did you Graduate?:  
Degree or Diploma:  
College:  
Name and Location of College  
Number of Years Completed:  
Did you Graduate?:  
Degree or Diploma:  
Education Information::  
Please select the highest level of education achieved.  
High School
College Degree
Employment Information
Can we Contact your previous employers?:  
Reason:  
We may contact the employers listed, unless you indicate those you do not want us to contact:  
Employer:  
Employer Address:  
Employer Phone:  
Immediate Supervisor and title (for most recent position):  
Date Employed From::   (mm/dd/yyyy)
Date Employed To::   (mm/dd/yyyy)
Weekly Pay:  
Job Title and Description of Work::  
Reason for Leaving::  
EMPLOYMENT #2:  
Employer Address:  
Name of Supervisor:  
Employer #2 Phone:  
Date Employed From::   (mm/dd/yyyy)
Date Employed To::   (mm/dd/yyyy)
Weekly Pay:  
Job Title and Description of Work:  
Reason for Leaving:  
EMPLOYMENT #3:  
Employer Address:  
Name of Supervisor::  
Employer #3 Phone:  
Date Employed From::   (mm/dd/yyyy)
Date Employed To::   (mm/dd/yyyy)
Weekly Pay::  
Job Title and Description of Work::  
Reason for Leaving:  
Have You Ever Served in the Military: *
(Complete this section if you have served in the U.S. Armed Forces)  
Describe your duties and special training::  
Branch of Service:  
Period of Active Duty From::   (mm/dd/yyyy)
To:   (mm/dd/yyyy)
Rank of Discharge:  
Date of Final Discharge:   (mm/dd/yyyy)
Skills
Skills: *
Word Processing/Word Spreadsheet/Excel
Presentation/Powerpoint Email/Outlook
Internet  
List any other Skills you may have:  
Document Upload
REFERENCES: *
List name and telephone number of three individuals familiar with your work experience.  
Resume:  
(txt,doc,docx,pdf)
Authorization For Human Resources
AUTHORIZATION FORM HUMAN RESOURSES
I understand that Progress Industries (“Company”) may obtain a consumer or investigative consumer report in connection with my application for employment. This means that the Company may obtain information on: • Credit history or credit standing • Criminal history • Driving record • Education record • Job history • Job reference information • Information about your character, reputation or personal characteristic I understand that the Company may seek this information both at the time of application for a job, and, if I am hired, at any time during my employment. By signing below, I am acknowledging that I have read this authorization and will allow the Company to obtain these reports. I further authorize the Company to share report information among affiliated companies as necessary in connection with hiring, promotion, job reassignment or retention of employment decisions. I release the Company from any and all liability which may result from information the Company receives through a report, and also release from liability any person or entity that provides information to the Company for this report. I expressly authorize all persons or entities with information necessary to create the report to release such information to the Company without any limitation or restriction. I understand that if I provide any false or misleading information to the Company during the hiring process, including information on the application for employment, I may not be hired. If the Company learns after I am hired that I provided false or misleading information during the hiring process or on the job application, I understand that I may face disciplinary action, including termination of my employment. I understand that nothing in this application for employment or anything said during the interview process creates an employment contract between the Company and me.
I understand this process is representative of an electronic signature and is legally binding on me.: *
Yes
 
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