www.coatingexcellence.

com
975 Broadway St, Wrightstown, WI 54180
1201 Aviation Blvd, Hebron, KY 41048

EMPLOYMENT APPLICATION
In compliance with federal and state equal employment opportunity laws, qualified applicants are considered for all
positions without regard to age, race, creed, color, handicap/disability, marital status, gender, national origin,
ancestry, sexual orientation, non job-related arrest or conviction record or any other basis prohibited by law.

Are you at least 18 years of age? Y 

✔ N 

Position(s) Applied For Type of Employment Date of Application

Full Time 
✔ 
Summer ✔ __________________________________
 Temporary 
Part Time ✔ ✔ Date Available for Work:

Name of Applicant Last Name First Name Initial(s)

Address (No., Street, City, State, ZIP)

Day Telephone Evening Telephone Desired Pay Range

( ) ( )
Previous Address if Less than 3 years
at address above

Education
Years Diploma/
School Name and Address of School Completed Major Subjects Degree

High School Y/N

College Y/N

Graduate Y/N

Other (specify) Y/N

Special Skills
1. If relevant, please describe word processing speed, software knowledge, and equipment experience.

2. If relevant, please describe experience using manufacturing machines and equipment.

3. Other Qualifications. (Summarize special job-related skills and qualifications acquired from employment or other experience.)

Form HR.APP001 Rev. B 11/12/2010

Work Experience (Start with most recent; use separate sheet if necessary.)
1. Name of Employer Telephone
( )

Address Name/Title of Immediate Supervisor

Job Title Employment Dates (month & year) May we contact for reference?
From To Yes  No 

Description of Duties Starting Compensation

Reason for Leaving Final Compensation

What did you like most about this job?

What did you like least about this job?

2. Name of Employer Telephone ( )

Address Name/Title of Immediate Supervisor

May we contact for reference?

Job Title Employment Dates (month & year)
Yes  No 
From To
Description of Duties Starting Compensation

Reason for Leaving Final Compensation

What did you like most about this job?

What did you like least about this job?

3. Name of Employer Telephone ( )

Address Name/Title of Immediate Supervisor

May we contact for reference?

Job Title Employment Dates (month & year)
Yes  No 
From To
Description of Duties Starting Compensation

Reason for Leaving Final Compensation

What did you like most about this job?

What did you like least about this job?

Form HR.APP001 Rev. B 11/12/2010

4. Name of Employer Telephone ( )

Address Name/Title of Immediate Supervisor

May we contact for reference?

Job Title Employment Dates (month & year)
Yes  No 
From To
Description of Duties Starting Compensation

Reason for Leaving Final Compensation

What did you like most about this job?

What did you like least about this job?

Are you available to work overtime? Yes  No  Have you ever been convicted or pleaded guilty/no contest to any
crime, misdemeanor or other offense, other than minor traffic
violations? Yes  No 
Are you available to work rotating shifts? Yes  No  If yes, describe the offense, date, sentence or punishment and
circumstances of each. (Convictions are not an automatic bar to
Are you available to work weekends? Yes  No  employment.)
If on layoff, are you subject to recall? Yes  No 

Do you have any obligations or prior agreements such as a non-

compete agreement that would restrict your working for us?
Yes  No 
Are you prevented from lawfully becoming employed in this
country because of a visa or immigration status? Yes  No 
(If hired, proof of citizenship or immigration status will be required)
Have you ever been employed with us before? Yes  No  Do you know anyone who works at CEI? Yes  No 
If yes, when? ______________________________________ Name: ______________________________________________

How were you referred to the company?  Agency Walk-In  Friend/Relative __________________________
 Newspaper  School  Other _________________________________

Have you ever been terminated or disciplined at a job? Can you travel if a job requires it? Yes  No 
Yes  No If so, list the employer, date and nature of offense. Do you have a valid driver’s License? Yes  No 

Personal/Professional References
Name Relationship Address Telephone

Form HR.APP001 Rev. B 11/12/2010

1. I hereby certify that all statements and facts set forth in my application are true and complete. I understand that any
false statement, concealment, or failure to answer any question fully and accurately, will be grounds for terminating
my employment, if I am hired by Coating Excellence International.

2. It is my understanding that the Company will make a thorough investigation of my employment history and may verify
all data given in my application for employment, related papers, or oral interviews.

3. I authorize investigation of all statements and matters contained in my employment application, which the Company
may deem relevant to my employment. I authorize all former employers and educational institutions to release to the
Company all information and records pertaining to me.

4. I release the Company, my past employers, and other people having information concerning me from all claims or
liabilities based on the inquiries or disclosure authorized by this agreement.

5. If I am offered employment, I consent to take a medical examination by a qualified physician at the discretion of the
Company, and I authorize any physician or hospital to release any information which may be necessary to determine
my ability to perform the duties of the job offered or in the future during my employment with the Company. I further
understand and agree that any medical examination I may receive includes a blood and/or urine test for substance
abuse.

6. If the substance abuse test is confirmed as positive, the results will be reported to the Company medical advisor. The
medical advisor will indicate to the Company that the candidate did not successfully pass the substance abuse test.
An exception will be considered for the use of legally purchased medications taken under the direction of a physician.

7. I understand that if I decline to sign this consent or interfere with any substance abuse test, or refuse to take the test,
my job offer may be withdrawn. In consideration of being reviewed for employment, I release the Company, its
subsidiaries and affiliates, assigns and agents, from any liability whatsoever incurred by them as a result of any
negligence, mistakes, errors, or omissions that result from a test report that is inaccurate, untrue or faulty in any
manner.

8. Although the Company makes every effort to accommodate individual preferences, business needs may at times
make the following conditions mandatory: rotating work schedules, overtime, shiftwork, weekend work, or reduction in
work schedules. I understand and accept these as conditions of my continuing employment.

9. If I become employed, I agree to comply with all Company rules, regulations and policies and read and understand all
policies and policy revisions as set forth by the Company, including a tobacco use and a drug and alcohol abuse
policy. I understand that failure to do so will subject me to disciplinary action up to and including termination of
employment. I also understand that any employment will occur on an at-will basis, meaning that either I or the
Company can terminate the employment relationship at any time, with or without notice, and with or without cause or
reason.

10. IMPORTANT. READ CAREFULLY BEFORE SIGNING THIS APPLICATION. WAIVER OF RIGHT TO JURY
TRIAL. If I am hired, Company and I agree, to the extent permitted by law, to waive a trial by jury in any action,
proceeding, claim or counterclaim brought or asserted by either Company or me on any matters whatsoever arising
out of or related to my application for employment or my employment with Company.

11. IMPORTANT. READ CAREFULLY BEFORE SIGNING THIS APPLICATION. SIX (6) MONTH TIME PERIOD TO
FILE ANY CLAIMS. If I am hired, Company and I agree, to the extent permitted by law, that any charge, claim, or
other action arising out of, or relating to, my employment at Company must be filed within six (6) months after the
charge, claim or action arises. I and Company both waive any contrary statute of limitations.

Dated this ________ day of ______________________________, 20 ____.

Signature of Applicant: _______________________________________________________________

Form HR.APP001 Rev. B 11/12/2010