Online Application

Eberhard Manufacturing Company

Equal Opprotunity Employer

Application for employment

First Name
Middle Name
Last Name
Street Address
Job Description
Years Experience
Available Start
Willing to work any shift

Personal Information

Have You ever been convicted of any law violation(except Minor traffic violations)?
* An applicant must answer this question unless the record has been expunged (sealed) pursuant to S1842.31 et seq. Ohio Revised Code. The question must nevertheless be answered if the nature of such conviction bears a direct and substantial relationship to the position for which the applicant has applied.
Hire is subject to verification that applicant meets legal age and U.S work permit requirements.


Have you ever worked here before ?
Have you ever worked here before
Have you ever interviewed here before ?
Please list any special skills or qualifications including computer skills, acquired military skills, etc.
If you are an experienced operator of any plant machines or equipment, please list


School Address (City/State) Major Studies Highest Level Completed Diploma, Degree, License or Certificate
High School
Vocational, Business, Etc.
List Any professional designations .

Employment History

Employed From/To Employer Name, Address & Phone (Most recent first) Name of Supervisor Job Duties Description Salary or Wage Reason for leaving
Can we contact your current employer ?

Military Service

Dates of service
Service U.S. Forces


In compliance with federal and state equal opportunity laws.. Applicants are considered for employemnt without regard to race, color, religion, gender, national origin, age, military status, or the presence of a disability which is subject to reasonable accomodation, veteran status, or any other status protected under focal, state or federal laws.


I certify all information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand the falsifications misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand submitting an application does not guarantee employment. I further understand should an employment offer be extended by Eberhard Manufacturing such employment with Eberhard Manufacturing is at witli for no specified duration and may be terminated by either Eberhard Manufacturing or myself at any time, with or without cause or notice unless otherwise indicated by an employment agreement.

I understand if offered a position with Eberhard Manufacturing, I may be required to submit to a background check, pre-employment drug screen and a physical as a condition of employment. I understand unsatisfactory results from, refusal to cooperate with, or any attempt to affect the background check, pre-employment drug screen and/or the physical will result in withdrawl of any employment offer or termination of employment if already employed. I also understand, in connection with and as a condition to hiring Eberhard Manufacturing may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics and mode of living. I hereby consent for Eberhard Manufacturing to make that request. Upon written request from me, Eberhard Manufacturing will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to Eberhard Manufacturing and/or any of its representatives, agents, or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information,

I understand that for employment, I agree to the following: I must meet employability requirements of the Federal Immigration and Naturalization Services and submit appropriate documentation to satisfy requirements for completing INS Fom 1-9 and the Homeland Security E-Verify process. I also agree to sign an invention and Confidentiality Agreement, if required.

By signing below I acknowledge I have read. understand and agree to the above statements,



Applicant Consent


(please print name) have read the foregoing Statement and understand

that the pre-employment screening proces indudes a urine test which may disclose the use of drugs or alcohol, or which may indicate substance abuse or chemical dependency.

I consent to such test and to the disclosure of the results to Eberhard Manufacturing for its internal use only.

I release and discharge Eberhard Manufacturing and any laboratory, which performs analysis from any claim or limitation, the testing procedures, the analysis or the disclosure of the results.

I further consent, if hired, to periodic drug/alcohol usage tests and to searches on Eberhard Manufacturing property of lockers, desks, lunch boxes and other areas which may belong or be assigned to me.



Position applied for

As an employer with an Affirmative Action Obligation pursuant to Executive Order 11246, we must comply with govemment regulations regarding the collection of demographic information about our employees and about those individuals being considered for employment with our organization. We are required to invite individuals being considered for employment to self-identify as to gender, ethnicity, and racial origin. Individuals invited to self-identify may do so immediately or at any time in the future. We are also required to invite all employees and applicants to self-identify for consideration under our Disabled Affirmative Action Program as well as where appropriate, veteran status.

If you believe that you are covered by the above Acts, the Organization invites you to self-identify for consideration under its Affirmative Action Programs. Provision of this information is voluntary and refusal to provide it will not subject the applicant or employee to adverse treatment. Further, if provided, the infomation will be kept confidential and used only in accordance with the Acts and regulations.

Please select classification

Voluntary Self-identification of Disability

Because we do business with the govemment, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. l 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 form 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 form without fear of any punishment because you did not identify as having a disability earlier.

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
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Deafness
  • Cerebral palsy
  • Major depression
  • Obsessive compulsive disorder
  • Cancer
  • Multiple sclerosis (MS)
  • Impairments requiring the use of a wheelchair
  • Diabetes
  • chizophrenia
  • Missing limbs or Intellectual disability (previously called mental
  • Epilepsy
  • Muscular partially missing limbs retardation) dystrophy
Please check one of the boxes below:

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Section 503 of the Rehabilitation Act of 19731 as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labors Office of Federal Contract Compliance Programs (OFCCP) website at www.d0t.gQYl.Qfccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. This survey should take about 5 minutes to complete.


As an employer with an Afirmatve Action Obligation pursuant to the Vietnam Era Readjustment Act, and/or the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), as appropriate, we must comply with govemment regulations regarding the collection of demographic information about our applicants. We are required to invite all applicants to setf-idenjfy for consideration under our Veteran Affirmative Programs. Provision Of this information is voluntary and refusal to provide it will not subject the applicant to adverse treatment. Further, if provided, the information will be kept and used only in accordance with the Acts and reguldons.

We are required to take afirmative action to employ and advanæ in employment: 1) disabled veterans; 2) recenty separated veterans; 3) active duty wartime or campaign badge veterans; and 4) Armed Forces Service Medal Veterans. Please see below for the definition of each classification.

Disabled Veteran: 1) a veteran of the U.S. Military, ground, naval or air service who is entitled to compensation (or who but for receipt of military retired pay would be entitled to compensation) under faws 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.

Recently Separated Veteran: Any veteran during the three-year period beginning on the date of such veterans discharge or release for active duty in the US. military, ground, naval, or air service.

Active Duty Wartime or Campaign Badge Veteran: Any veteran who served on active duty during a war or in a campaign or expedition for which a campaign badge has been authorized. A list of qualifying wars, campaigns and is attached.

Armed Forces Service Medal Veteran: This award, authorized by Executive Order 12985 Jan. 11, 19961 is awarded to members of the armed forces of the U.S. who, after June 1992: 1) participate, have participated, as members of U.S. military units, in a U.S. military operation that is deemed be or significant by the Joint Chiefs of Staff; and 2) encounter no foreign armed opposition or imminent threat of hostile action.

If you believe you belong to one or more of fie categories of protected veterans listed above, please indicate by checking the appropriate box below, As a govemment we request this information in order to measure the effectiveness of he outreach end positive recruitment efforts we undertake pursuant to VEVRAA.

Please check one of the boxes below: