Name(Required)
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Present Address(Required)
May we contact you at work?(Required) Select the shifts you're available to work(Required) Check all that apply(Required) Can you work overtime?(Required) Are you willing to relocate?(Required) Are you authorized to work in the US?(Required) If no, have you applied for work authorization?(Required) What led you to apply for a position at this company?(Required) Within the last 7 years have you been convicted of a felony or finished serving a prison sentence for a felony conviction?(Required) Note: Conviction of a felony is not an absolute bar to employment; however, a conviction may be relevant in determining the suitability of an applicant for a particular job.
You may answer "no" if your only felony conviction(s) has been annulled or expunged from court records, or is contained in a sealed or juvenile record or you have been officially pardoned. For California applicants only, you may omit reference to any marijuana-related offense if the date of the conviction is more than two years ago.
If the position you are applying for requires a security clearance, have you ever had a security clearance suspended, denied, or revoked:(Required) If yes:(Required)
Education Please check each level of education you have completed
High School Address of High School(Required)
Bachelor or Associate Degree Address of College / University
Masters Degree
Doctoral Degree
Vocational, Military, or Technical School Training and Business Skills List of all business machines / software that you can proficiently operate:
Please list anything that applies. You may skip this if the question is not applicable.
List all technical / shop machines that you can proficiently operate:
Please list anything that applies. You may skip this if the question is not applicable.
Misc Education Collegiate Extracurricular Activities and Honors:
Please list anything that applies. You may skip this if the question is not applicable.
Published Papers or Thesis/Dissertation (if thesis or dissertation, indicate advisor) or Honors you have received:
Please list anything that applies. You may skip this if the question is not applicable.
Professional Societies of which you have been a member and offices held (include any licenses you hold):
Please list anything that applies. You may skip this if the question is not applicable.
Previous Employment History How many jobs have you had in the past 5 years?(Required)
Previous employment #1 Reason for leaving(Required)
Previous employment #2 Reason for leaving(Required)
Previous employment #3 Reason for leaving(Required)
Previous employment #4 Reason for leaving(Required)
Previous employment #5 Reason for leaving(Required)
Professional Business References who may be contacted by Metglas, INC.
Employee/Applicant Self Identification Name(Required)
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Address(Required)
Metglas, Inc. - Conway, SC is subject to certain governmental recordkeeping and reporting
requirements for the administration of civil rights laws and regulations. In order to comply with these
laws, Metglas, Inc. - Conway, SC invites you to voluntarily self-identify your sex, ethnicity, and race.
Submission of this information is voluntary and refusal to provide it will not subject you to any
adverse treatment. The information will be kept confidential and will only be used in accordance with
the provisions of applicable laws, executive orders, and regulations, including those that require the
information to be summarized and reported to the federal government for civil rights enforcement.
When reported, data will not identify any specific individual. If you do not wish to furnish this
information, please initial in the section below.
Please check the appropriate boxes
Voluntary Self Identification of Disability Why are you being asked to complete this form? Because we do business with the government, we must reach out to, hire, and provide equal opportunity to
qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if
you have a disability or if you ever had a disability. Completing this fonn is voluntary, but we hope that you will
choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used
against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may
become disabled at any time, we are required to ask all of our employees to update their information every five
years. You may voluntarily self-identify as having a disability on this fonn without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I have a disability? You are considered to have a disability if you have a physical or mental impairment or medical condition that
substantially limits a major life activity, or if you have a history or record of such an impairment or medical
condition.
Disabilities include, but are not limited to:
• Blindness • Autism
• Deafness • Cerebral palsy
• Cancer • HIV/AIDS
• Diabetes • Schizophrenia
• Epilepsy • Muscular
dystrophy
• Bipolar disorder
• Major depression
• Multiple sclerosis (MS)
• Missing limbs or
partially missing limbs
Please check one of the boxes below:
• Post-traumatic stress disorder (PTSD)
• Obsessive compulsive disorder
• Impairments requiring the use of a wheelchair
• Intellectual disability (previously called mental
retardation)
Please select one of the following(Required) INVITATION TO SELF-IDENTIFY AS A PROTECTED VETERAN 41 CFR 60-300 Metglas, Inc. - Conway, SC is a Government sub-contractor subject to the Vietnam Era Veterans' Readjustment
Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which
requires Government contractors to take affirmative action to employ and advance in employment: ( 1 ) disabled
veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed
Forces service medal veterans. Our Affirmative Action Plan is designed to set forth and measure the
effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. The
classifications of protected veterans are defined as follows:
• A "disabled veteran" is: (1) A veteran of the U.S. military, ground, naval or air service who is
entitled to compensation ( or who but for the receipt of military retired pay would be entitled to
compensation) under laws administered by the Secretary of Veterans Affairs, or (2) A person
who was discharged or released from active duty because of a service-connected disability.
• A "recently separated veteran" means any veteran during the three-year period beginning on
the date of such veteran's discharge or release from active duty in the U.S. military, ground,
naval or air service.
• An "active duty wartime or campaign badge veteran" means a veteran who served on active
duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition
for which a campaign badge has been authorized, under the laws administered by the
Department of Defense. Go to http://www.opm.gov/staffingportal/vqmedal2.asp for a list.
• An "Armed Forces service medal veteran" means any veteran who, while serving on active duty
in the U.S. military, ground, naval or air service, participated in a United States military
operation for which an Armed Forces service medal was awarded pursuant to Executive Order
12985 (61 FR 1209). Go to http://www.opm.gov/staffingportal/vqmedal2.asp for a list.
If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking
the box below. Submission of this information is voluntary and refusal to provide it will not subject you to any
adverse treatment. The information provided will be used only in ways that are not inconsistent with the Vietnam
Era Veterans' Readjustment Assistance Act of 1974, as amended.
Please select one(Required) DISCLOSURE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT I, the undersigned consumer, do hereby authorize Metglas, Inc., through a consumer reporting agency of its choice,
to procure a consumer report and/or investigative report on me at this time or at any later time if I become
employed by Metglas, Inc ..
These above-mentioned reports may include, but are not limited to,_ employment and education verifications;
personal references; personal inteJViews; my personal credit history based on reports from any credit bureau; my
driving history, including any traffic citations; a social security number verification; present and former addresses;
criminal and civil history/records; any other public record; and any other information bearing on my credit
standing, credit capacity, credit worthiness, character, general reputation, personal characteristics, trustworthiness
and/or mode of living.
I understand that the investigative consumer report I have authorized may include information obtained by
inteJViews with my neighbors, friends and/or associates and/or others with whom I am acquainted or who may
have knowledge concerning said information. I understand that I am entitled to a complete and accurate disclosure
of the nature and scope of any investigative consumer report prepared on me upon my written request to Metglas,
Inc. or the consumer reporting agency that is made within a reasonable time after the date hereof. •
I further authorize any person, business entity or governmental agency who may have information relevant to the
above to discuss and disclose the same to Metglas, Inc., by or through a consuiner reporting agency, including, but
not limited to any courthouse, any public agency, any and all law enforcement agencies and any and all credit
bureaus, regardless of whether such person, business entity or governmental agency compiled the information itself
or received it from other sources.
I hereby release Metglas, Inc., the consumer reporting agency asked to provide this information, and any and all
persons, business entities and governmental agencies, whether public or private, from any and all liability, claims
and/or demands, of whatever kind, to me, my heirs or others making such claim or demand on my bebatt: for
procuring, selling, providing, brokering and/or assisting with the compilation or preparation of the consumer
report and/or investigative consumer report hereby authorized.
Name(Required)
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Address(Required)
DISCLOSURE OF REQUEST FOR AN INVESTIGATIVE CONSUMER REPORT. This is to advise you that Metglas, Inc. may request an investigative consumer
report concerning you~ either at time you apply for employment with Metglas, Inc. or at
any later time if you become employed. An investigative consumer report is a special kind
of consumer report that may include information concerning your character, general
reputation, personal characteristics and mode of living that may be obtained tmough
personal interviews. •
If Metglas, Inc. requests an investigative consumer report, you have the right to
make a ~n request to Metg]as, Inc.t o obtain: (1) a written summaryof your rig},tts
under the Federal Fair Credit Reporting Act (FCRA) and (2) a complete and accurate
disclosure of the nature and scope of the investigative consumer report requested by
Metglas, Inc .. If you request disclosure concerning the investigation's nature and scope, it
will be provided to you Il() later than five days after Metglas, Inc.
Agreements I AUTHORIZE THE VERIFICATION OF(Required) All information given
I understand that any omission or misrepresentation by me in this application may be cause for immediate dismissal and that any offer of employment is contingent upon satisfactory results of a job-related medical examination where applicable, a urine drug screen by a company designated physician at company expense, where applicable, and a successful background investigation. I understand I may be required to take and pass an employment test and/or provide a military discharge certificate before | begin employment.
