Employment Application Before being employed by Dutch Made Custom Cabinetry, applicants must pass a physical exam, vision test, and drug test. If you have a problem submitting these, please do not complete application. "*" indicates required fields Name* First Last Date* MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Have you ever worked at Dutch Made before?* Yes No Rate of Pay Expected:* Can you work:* Full-Time Part-Time Can you provide a valid Indiana Drivers License?* Yes No Referred By: Name of Relative/Friend working for us (if applicable): List any special skills/machinery you can operate: Do you have any experience in the following: Manufacturing Machinery Glazing Staining Spray Booth Assembly Have you ever been arrested for or convicted of a crime that has not been expunged by a court?* Yes No If yes, please explain:* Employment HistoryEmployer Name: Rate of Pay: Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Reason For Leaving: Position Title/Duties, Skills: Employer Name: Rate of Pay: Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Reason For Leaving: Position Title/Duties, Skills: Employer Name: Rate of Pay: Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Reason For Leaving: Position Title/Duties, Skills: Employer Name: Rate of Pay: Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Reason For Leaving: Position Title/Duties, Skills: Education (Name and Location)High School: Did you graduate? Yes No Degree Diploma GED College: Degree Received: Degree of Study: Other specialized training/courses/skills, etc.: Applicant Statement I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and accurate. I hereby grant permission to investigate any of the information included in this application as necessary to arrive at an employment decision. I understand that I must pass a medical examination and a drug screen test as part of the hiring process. I understand nothing contained in this employment application or in the granting of an interview is intended to create a contract between me and Dutch Made Custom Cabinetry for either employment or benefits. I further understand that if hired, my employment will be at will, and both the company and myself remain free to choose to continue or end our work relationship at any time without cause and to continue or end our employment relationship at any time. I understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard. Dutch Made Custom Cabinetry is an equal employment opportunity employer and does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under federal, state or local laws. I certify that I have read, fully understand and accept all terms of the Applicant Statement.Upload your resumé, cover letter, and/or portfolio to this application. (Optional) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB, Max. files: 3. Signature*Date MM slash DD slash YYYY Write the Correct Measurement in the Space Provided Click the images to view larger sizes.Measurement* Measurement* Measurement* CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Fill out Online Application Have Questions? AMANDA GALE HR Generalist amanda.gale@dutchmade.com (260) 657-3311 To access the machine-readable files created and published by Anthem BCBS, please click here.