Submit Application - Page 1

Application for Employment

We appreciate your interest in Aisin. Aisin is an equal employment opportunity employer. Aisin's policy is not to discriminate against any applicant or employee based on race, color, sex, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Aisin also prohibits harassment of applicants or employees based on any of these protected categories. It is also Aisin's policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.
Note to Applicants: Aisin does not currently have any positions that would be open to children, minors and applicants under the age of eighteen (18).
Define: Throughout this Application the terms "Aisin" shall include Aisin World Corporation of America, Inc., Aisin Holdings of America, Inc., as well as any of its affiliates, subsidiaries, parent companies. The term "Company" is used interchangeably with "Aisin" in this Application.

General Information

Please complete all requested information.
Location: Aisin Manufacturing Illinois
Today's Date: 09/16/2019
First Name:
Middle Name:
Last Name:
Street Address:
City:
State:
Zip:
Have you ever used any other name(s) which is (are) necessary for us to know in order for us to verify your employment or educational record?
If yes, please provide the other name(s):
Have you previously worked for or applied for a position with Aisin or another Aisin organization in any of our locations either as an employee or through an employment agency?
If yes, please explain when and, if employed, in what capacity:
Position Applying For: Die Maintenance Technician
Minimum Salary Desired:
Date Available for Work (MM/DD/YYYY):
Are you at least 18 years old?
Telephone (Home):
Telephone (Work):
Email Address:
Are you available to work overtime as needed?
If available to work overtime, are you available weekdays?
If available to work overtime, are you available weekends?
Are you related to or in a close personal relationship with anyone now employed at Aisin? (An answer of "Yes" will not automatically disqualify you from the position for which you are applying.)
If yes, state name(s) and where they are located.

Permission to Work

Are you legally authorized to work in the United States?
Will you now or in the future require sponsorship for employment visa status (e.g. H-1B status)?

Referral Information

How did you become aware of this open position?
Employment Agency (state name):
Internet/Website:
Referral (state name):
School (state name):
Professional Organization:
Other:

Work Experience

Please specify your complete full-time and part-time employment history, including self-employment and volunteer work. You may include any verified work performed on a volunteer basis. Begin with your most recent employer. If you require additional space, please use the reverse side of this page and/or the following page
Albany (New York), California, Connecticut, Delaware, Massachusetts, New York City, Oregon, Vermont and Westchester County (New York) Applicants: Do not provide information about prior salary, wages, or other compensation. Leave "Monthly Wages" blank.

Previous Employment 1

Company Name:
Address:
Name, Title, and Phone Number of Supervisor:
Job Title, and Work Responsibilities:
Telephone:
Employed From (MM/YYYY):
Employed To (MM/YYYY):
Monthly Wages Start:
Monthly Wages Last:
Reason for Leaving:

Previous Employment 2

Company Name:
Address:
Name, Title, and Phone Number of Supervisor:
Job Title, and Work Responsibilities:
Telephone:
Employed From (MM/YYYY):
Employed To (MM/YYYY):
Monthly Wages Start:
Monthly Wages Last:
Reason for Leaving:

Previous Employment 3

Company Name:
Address:
Name, Title, and Phone Number of Supervisor:
Job Title, and Work Responsibilities:
Telephone:
Employed From (MM/YYYY):
Employed To (MM/YYYY):
Monthly Wages Start:
Monthly Wages Last:
Reason for Leaving:

Previous Employment 4

Company Name:
Address:
Name, Title, and Phone Number of Supervisor:
Job Title, and Work Responsibilities:
Telephone:
Employed From (MM/YYYY):
Employed To (MM/YYYY):
Monthly Wages Start:
Monthly Wages Last:
Reason for Leaving:
All employers including your current employer may be contacted to verify the information you provide.
May we contact your current employer prior to any offer of employment?
Will you attach a resume to this application (next page)?
If you are attaching your resume, please read the following and initial where indicated: I, the applicant, acknowledge and agree that the information in my attached resume is accurate, true and correct in all material aspects. I also acknowledge and agree that any falsification, omission and/or other deliberate inaccuracy therein will lead to my immediate disqualification of consideration for employment by Aisin.
Initials:

Professional References

Individuals not related to you. Business references preferred.

Reference 1

Name:
Occupation:
Phone:
Address:
Years Known and Capacity:

Reference 2

Name:
Occupation:
Phone:
Address:
Years Known and Capacity:

Reference 3

Name:
Occupation:
Phone:
Address:
Years Known and Capacity:

Education & Training

Please include name, street, city, state and zip code for each school.

Graduate School

Name and Location of School:
Number of Years Completed:
Graduated? Y/N. If so, List Degree Received:
Type of Course/Major:

College

Name and Location of School:
Number of Years Completed:
Graduated? Y/N. If so, List Degree Received:
Type of Course/Major:

High School

Name and Location of School:
Number of Years Completed:
Graduated? Y/N. If so, List Degree Received:
Type of Course/Major:

Business/Trade/Technical School

Name and Location of School:
Number of Years Completed:
Graduated? Y/N. If so, List Degree Received:
Type of Course/Major:

Job - Language Skills

Language Skill 1

Language
Verbal Skill Level
Written Skill Level

Language Skill 2

Language
Verbal Skill Level
Written Skill Level

Job - Other Skills

Please list other skills that you believe make you especially qualified for employment with Aisin

Other Skill 1

Skill Description
Competence Level

Other Skill 2

Skill Description
Competence Level

Other Skill 3

Skill Description
Competence Level

Additional Employment Inquiries

If applying for a position that includes driving:
If hired, can you provide a valid driver's license?
If hired, you may be required to provide evidence of insurance or insurability.
If hired, are you subject to any non-compete agreements or other agreement(s) that would impact your ability to work for Aisin?

Emergency Contact Person

Name
Phone Number

Applicant's Statement & Acknowledgment

THIS APPLICATION IS NOT COMPLETE UNTIL IT IS FULLY COMPLETED, SIGNED, AND ALL STATEMENTS BELOW HAVE BEEN READ AND INITIALED.

I certify that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge. I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered.
Initials
I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause or notice. I understand that only the President of Aisin, and no manager, supervisor, or other representative of the Company, has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the at-will employment relationship, and with respect to any agreement entered into by the [insert position listed above], any such agreements must be in writing and signed by the [insert position listed above] and by me or my authorized representative.
Initials
I further understand and agree that, except for my at-will employment status, if hired, my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by Aisin.
Initials
I understand that if I am offered employment, I may be required to sign a confidentiality, non-solicitation and non-disclosure agreement, as a condition of the employment.
Initials
I understand that the Company may share the information contained in this application with other Company employees, such as payroll, benefits and finance, for employment and administrative purposes and hereby consent to such transfer.
Initials
I hereby authorize, to the extent allowed by applicable federal state and local laws, Aisin to conduct its own investigation of my references, resume, employment history, and education and, further, authorize the references and prior employers I have listed to disclose to the Company information related to my employment history and qualifications for the position for which I am applying, without giving me prior notice of such disclosure.
Initials
I understand and expressly agree that if employed by the Company, storage areas provided for me (locker, desk, etc.) are open to investigation by the Company without prior notice to me.
Initials
I agree to submit to legally permissible drug testing upon an offer of employment from Aisin and prior to starting work. I agree that any offer of employment is contingent upon my receiving a negative test result.
Initials
I understand that it may be necessary depending upon the position that you are seeking at Aisin to perform a background check. Please note that if such a need arises, you will be requested to provide such authorization in writing on a separate form.
Initials
My signature below certifies that I agree to be bound by the terms and conditions stated in this application, which contains all the understandings between the Company and me concerning the topics addressed herein and supersedes any prior inconsistent understandings between the Company and me on such issues.
Applicant's Signature
Date: September 16, 2019
This application will only be considered for 30 days. If you have not been hired within 30 days of submitting this application and you wish to continue to be considered for employment, you must complete another application.

Applicant Identification Record

OPTIONAL/VOLUNTARY

Thank you for your interest in Aisin World Corp. of America.
Federal and state regulations require employers to obtain certain information from each job applicant. This form is used to provide each applicant with an opportunity to furnish such information voluntarily.
All information that is provided voluntarily:
- Will be used only for record-keeping purposes.
- Will be kept separate from the application for employment and an employee's main personnel file.
- Will not be used for any discriminatory purposes.
AWA is an equal employment opportunity employer and committed to a diverse work environment. Thank you.
Position Applied For: Die Maintenance Technician
Application Date: September 16, 2019
Date of Birth (MM/DD/YYYY):
Sex:
Race:
Black Caucasian Hispanic Other
If Other Race:
National Origin: