Application for Employment at ProPulse

Qualified applicants receive equal consideration. No question is asked for the purpose of securing information to be used to discriminate against any applicant due to race, creed, color, national origin, religion, age, sex, disability, veteran status, marital status, sexual orientation, or any other characteristic protected by law. We are an equal opportunity employer. This application is valid and will be considered for up to 30 days after it is received. For reconsideration after that time, you must submit a new application form.

ProPulse, A Schieffer Company is an Equal Opportunity employer and is proud to have a drug-free environment. All employment offers are contingent upon applicant successfully completing drug and background screenings.

"*" indicates required fields

PART 1: GENERAL INFORMATION

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone Number*

Email*

Salary Requirements*

Start Date Available*

MM slash DD slash YYYY

How did you hear about us?*

Mail Piece

Friend

Relative

Social Media

Website

Current Employee

Other

What Current Employee?*

If you selected other, how did you find out about ProPulse?*

Do you have any relatives employed by ProPulse?*

Yes

If yes, who? What is the relation?

Have you ever applied or interviewed with us before?

Yes

If yes, when and what position?*

Are you covered by the terms of a non-compete agreement?*

Yes

Are you at least 18 years of age?*

Yes

Are you eligible to work in the United States?*

Yes

Work Desired*

Full-Time

Part-Time

What shift/shifts are you interested in?*

1st Shift

2nd Shift

3rd Shift

What position are you applying for?*

UPLOAD A RESUME OR FILL OUT PARTS 2-6 OF APPLICATION

For a quick-application, please upload a resume. If you are not uploading a resume, please fill out Parts 2-6 of the application.

Would you like to submit a resume or fill out Parts 2-6 of application?*

Upload a resume

Fill out Parts 2-6

Upload A Resume*

Max. file size: 32 MB.

PDF Version is Preferred

PART 2: EDUCATION

What is your highest level of Education completed?

Grade School Name

Years

City

State

High School Name

Years

City

State

College Name

Years

City

State

Degree Obtained

Major

Minor

Higher Education

Years

City

State

Degree Obtained

Major

Minor

Business or Trade School

Years

City

State

Degree or Certificate Obtained

PART 3: EMPLOYMENT HISTORY

Current/Previous Employer #1*

Position Title

Phone

Supervisor Name

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Street Address

City

State

It is okay to contact this employer?*

Yes

What duties were you responsible for and what was your reason for leaving?

Current/Previous Employer #2

Position Title

Phone

Supervisor Name

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Street Address

City

State

It is okay to contact this employer?

Yes

What duties were you responsible for and what was your reason for leaving?

Current/Previous Employer #3

Position Title

Phone

Supervisor Name

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Street Address

City

State

It is okay to contact this employer?

Yes

What duties were you responsible for and what was your reason for leaving?

PART 4: SKILLS-SETS

What skills or experience can you bring to the table?*

(Please check all that apply.)

Microsoft Word

Microsoft Excel

Microsoft Power Point

Microsoft Outlook

Forklift Driving

Assembly

Manufacturing

Foreign Language

PART 5: MILITARY SERVICE

Have you ever served in the armed forces?

Yes

Were you honorably discharged?

Yes

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Which branch of the armed forces did you serve?

Reason for leaving the armed forces?

Do you have a DD214?

Yes

Where was it filed at?

PART 6: REFERENCES

Please list three professional references. These references must be individuals that you worked with or worked for and can tell us about you as any employee. We do not want personal references such as relatives or acquaintances.

Name

First Last

Relationship

Address

Street Address City State / Province / Region ZIP / Postal Code

Personal Phone

Personal Email

Work Phone

Work Email

Name

First Last

Relationship

Address

Street Address City State / Province / Region ZIP / Postal Code

Personal Phone

Personal Email

Work Phone

Work Email

Name

First Last

Relationship

Address

Street Address City State / Province / Region ZIP / Postal Code

Personal Phone

Personal Email

Work Phone

Work Email

QUESTIONS OR COMMENTS

Do you have any additional questions or comments?

Agreement*

I hereby authorize ProPulse and its agents and employees to contact and seek from any of my previous employers and any schools which I have attended, any and all information they may have concerning my employment or scholastic history, salary history, character, habits, abilities, performance, attitude, business and school activities and problems, and cause for leaving, and I hereby authorize each such employer and school to release such information to ProPulse or any agent or employee acting on its behalf. I hereby release each such employer and school and their agents and employees from any and all liability of whatever nature by reason of furnishing such information to ProPulse or any agent or employee thereof, and I further release ProPulse and its agents and employees from any and all liability of whatever nature by reason of requesting, receiving or acting upon such information. I hereby certify that all statements and information provided by me in this application for employment and statements given by me during any employment process are true, correct, and complete. I understand that my background and the information provided by me in connection with my application will be carefully checked, and I authorize investigation of all statements contained in this application. It is agreed and understood that the employer may investigate the applicant’s background which may include, but not be limited to, criminal conviction checks, educational record checks, credit checks, and references from employers, associates. The inquiry may include, but not be limited to, information regarding my character, general reputation, and personal characteristics. The applicant releases former and/or current employers and other individuals contacted from all liability for any damages for furnishing factual information. This agreement also serves as notification that you are entitled to certain reports, along with a description of consumer’s rights required by the Federal Credit Reporting Act. You must make this request in writing to the ProPulse Human Resources Department. Any misrepresentation or omission of information will be sufficient cause for rejection of this application or, if employment has commenced, grounds for immediate dismissal. I further understand that any offer of employment is contingent upon a complete check of my references, prior employment, education, and background. This agreement also serves as notification that the Dubuque facility is a “No Smoking” building in accordance with the Iowa Smoke free Air Act. As a condition of employment, applicant agrees that all information which is received in the course of my employment relating in any manner to the business activities, programs, concepts, or designs of ProPulse or any of its affiliates are to be treated by applicant as trade secrets and kept in confidence, not to be disclosed to any unauthorized person either during or after my employment, or used by applicant in any manner adverse to the interests of ProPulse I consent to take any physical examination (including drug/alcohol testing) requested by the Company in connection with the processing of my application for employment, and I further agree to take any physical examinations requested by the Company during my employment should I be offered and accept a position. In case inquiry is made of the ProPulse for information regarding my record with it, my personal character, habits, ability, and cause for leaving its service, I hereby release the Company from any and all liability for damage or otherwise in connection with the furnishing of such information. I understand and agree that my employment and compensation are for no definite periods of time and may be terminated, with or without cause, and with or without notification, at any time. I understand that no manager or representative ProPulse, other than the President and CEO thereof, has any authority to enter into an agreement for employment for any specified period of time or to make any agreement contrary to the foregoing, and any such agreement, to be enforceable, must be in writing and signed by the President and CEO of ProPulse. Additionally, it is understood that nothing contained in this application, nothing in the company policies, or in the granting of an interview is intended to create or should be construed as an employment contract between the applicant and ProPulse. Qualified applicants receive equal consideration. No question is asked for the purpose of securing information to be used to discriminate against any applicant due to race, creed, color, national origin, religion, age, sex, disability, veteran status, marital status, sexual orientation, or any other characteristic protected by law. We are an equal opportunity employer. This application is valid and will be considered for up to 30 days after it is received. For reconsideration after that time, you must submit a new application form. No promise regarding employment and/or for any period of employment, is binding on ProPulse unless made in writing by the President of the company. If an employment relationship is established, it is understood that the employment will not be for a definite duration, and both the applicant and ProPulse have the right to terminate employment at will.

By checking this box I hereby certify that I have read the agreement above and authorize it.

Certification of Application*

By checking this box I hereby certify that this application was completed by the applicant, and that all entries on it and information in it are true and complete to the best of my knowledge.

Phone

This field is for validation purposes and should be left unchanged.