Please provide complete and legible information when filling out the form below. An incomplete application may affect your consideration for employment. If necessary, attach a separate sheet for additional information.

If you’d prefer to print this form out and mail it to our offices, click here to download the PDF. Please mail your application a cover letter attached to:

Silvex, Inc.
Attn: Melanie Wiker
45 Thomas Drive
Westbrook, ME 04092

Silvex Inc. is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee based on race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, veteran or military status, citizenship status, genetic information, sexual orientation, gender identity or expression, marital status, or any other legally recognized protected basis under federal, state, or local law. The information collected by this application is solely to determine suitability for employment, verify identity, and maintain employment statistics on applicants.

Applicants with disabilities may be entitled to reasonable accommodation under the Americans with Disabilities Act and Maine Human Rights Act. A reasonable accommodation may assist in ensuring an equal employment opportunity without imposing undue hardship on Silvex. Please inform Human Resources if you need assistance completing this application or to otherwise participate in the application process.

Your application will be active for 60 days. If you are not hired during that time but wish to continue to be considered for available positions, you must complete a new application.

GENERAL INFORMATION



TYPE OF WORK DESIRED


EDUCATION

High School



College



Graduate School



Trade, Business Night School or Courses



Other



SKILLS/CERTIFICATIONS RELEVANT TO POSITION

MILITARY INFORMATION




BACKGROUND INFORMATION

EMPLOYMENT HISTORY

List all employment experience for the past 10 years, starting with the most recent or present employer. Using a separate section for each position, describe in detail all work experience. You may include as part of your employment history any verifiable work performed on a volunteer basis. Resumes may not be substituted in lieu of completing the following employment information.

Employer 1



Date of employment



Employer 2



Date of employment



Employer 3



Date of employment



Employer 4



Date of employment



Personal References

(Please list at least 3 non-family member references (other than those listed as a current/former supervisor) that we may contact.)

Reference 1



Reference 2



Reference 3



Reference 4



I understand that I may be subject to a pre-employment medical examination after receiving a conditional offer of employment and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with Silvex. I further understand I will be subject to a pre-employment background check after receiving a conditional offer of employment to investigate my criminal background, driving record, credit history, and other matters related to my suitability for employment. I understand that a separate disclosure and consent form will be provided to me prior to any background check. I understand that any offer of employment with Silvex is contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.

I authorize Silvex and its representatives to contact my current and former employers (with the exception of if I have marked “May we contact?” as “No”), schools, references, and other persons or organizations I have named in this application for the purpose of verifying the information I have provided. I release my current and former employers, schools, references, and other persons or organizations named in this application from any liability resulting from the information released. I authorize employers, schools, and other persons or organizations named in this application to provide any information or transcripts requested.

I certify that, if employed, my employment with Silvex will not conflict with, violate, breach, or result in default under, any contract, agreement, or understanding that I am a party to or am bound by, including any non-solicitation, non-competition, or other similar post-employment restriction or agreement I have with any current or former employer.

I certify that all of the above information is true and complete and I understand that any falsification or omission of information made by me may disqualify me from further consideration for employment or, if hired, may result in my termination at any time during the period of my employment, regardless of the amount of time that has passed.

MY SIGNATURE IS EVIDENCE THAT I HAVE READ AND AGREE WITH THE ABOVE STATEMENTS.