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APPLICATION FOR EMPLOYMENT

Sussek Machine Company
805 Pierce Street
Waterloo, WI 53594
(T) 920-478-2126 (F) 920-478-3452
www.sussek.com

TO APPLICANT: We appreciate your interest in our organization. Thank you for taking the time to complete this application in its entirety. It is the policy of this company to provide equal opportunity with regard to all terms and conditions of employment. The company complies witrh federal and state laws prohibiting discrimination on the basis of race, color, religion, creed, national origin, disability, veteran status, age, or any other protected characteristic.

Date of Application
May 133, 2025

NOTICE TO APPLICANTS

Drug/Alcohol testing is required as part of the employment process.

First Name

Middle

Last Name

Street Address

City

State

Zip

Home Phone

Cell Phone

Type of employment desired Full Time Part Time Temporary Internship Other

Position applying for

Shift preferred 1 2 3 Any

Date available for work

Expected salary range

Referral source Website/Internet Employee/Friend Walk-in Ad Other

Name of referral source

Have you submitted an application here before?

Yes No

If yes, provide date & position

Have you ever been employed here before?

Yes No

If yes, provide date & position

Are you legally eligible for employment in the USA? If yes, proof is required if hired

Yes No

If you are under 18 years old, Can you provide a work permit if required?

Yes No

Are you able to perform the 'essential functions' of the job for which you are applying for (with or without reasonable accomodation)?

This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Yes No Need more information about the jobs "essential functions" to respond

Explain any gaps in employment, other than those due to personal illness, injury or disability

References

	Name and Occupation	Relationship	Phone Number	E-mail	Years Known
1
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3
4

Will you be uploading a resume? Yes
No. I will enter my recent employment and education on the following page.

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