Application

Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, creed, disability, marital or veteran status, ancestry, sexual orientation, arrest conviction record, membership in any government or military unit.
If you experience any problems while completing or submitting this application, please contact us at 920-766-5795.

Position applying for

Name

Address

Phone Number

What is the best time to reach you?

Driver Information

Have you filled out an application here before?

Have you ever been employed by Keller, Inc.?

Do you currently work a full time job?

Will you continue to work full time for another employer if you are hired for the position for which you are applying?

May we contact your present employer?

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

Proof of citizenship or immigration status may be required upon employment.

Are you available to work:

Are you on a layoff?

If yes, are you subject to recall?

Can you travel if the job requires it?

Indicate languages you speak, read, and/or write:

Fluent Good Fair
Speak
Read
Write

Give name, address and telephone number of three (3) references who are not related to you and are not previous employers:


Scope of Obligation

State and Federal laws specify that it is unlawful for employers ……

To discriminate against otherwise qualified applicants in recruiting, advertising, job application procedures, hiring, terms, conditions or privileges of employment, promotion, compensation, disciplinary action, discharge or termination on the basis of age, race, creed, color, disability, marital status, sex, sexual orientation, national origin, ancestry or conviction record, membership in any military unit or the use of lawful products off the employer’s premises during non-work hours.

Employment experience

Please start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin.

Employer 1

Dates Employed
From To
Hourly Rate/Salary
From To

Employer 2

Dates Employed
From To
Hourly Rate/Salary
From To

Employer 3

Dates Employed
From To
Hourly Rate/Salary
From To

Employer 4

Dates Employed
From To
Hourly Rate/Salary
From To

Special Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experience.


Education

High School

 
Years Completed
Diploma/Degree

Technical School

 
Years Completed
Diploma/Degree

College/University

 
Years Completed
Diploma/Degree

State any additional information that you feel may be helpful to us in considering your application:

In paragraph form:

I certify that answers given herein are true and complete to the best of my knowledge.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the company.

You must be 18 years of age to work at Keller, Inc.

I authorize permission to do a license, motor vehicle, and credit check for employment reasons when applicable.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not and is not intended to be a contract of employment.

I understand that all employees of Keller, Inc. are considered employees at will.