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Personal Data

Are you under Age 18?*


Are you a Citizen of the United States?*


Military Information

Were you in the U.S. Armed Forces?*



Have you ever been convicted of a felony?*


Have you been convicted of a misdemeanor committed within the past 5 years, or were you imprisoned for a misdemeanor which occurred more than 5 years ago?*


Job Interest

Were you ever employed by Adams Manufacturing in the past?*

How did you learn of this vacancy?

Education and Training

Select the highest grade completed in each school category:

High School

Tech School


Grad School

High School



Other Job Related Activities

Employment History

Please read carefully before starting. List all employment starting with present or most recent employer. Account for all periods, including unemployment and service with the Armed Forces. Include relevant voluntary and/or part-time work experience.

Employee Release and Privacy Statement

Please read this carefully and check the box indicating your understanding and agreement before submitting:

I understand that Adams Manufacturing requires certain information about me to evaluate my qualifications for employment and to conduct business if I become an employee. Therefore, I authorize Adams Manufacturing to investigate my past employment, educational credentials, other employment-related activities, and criminal conviction record, if any. I agree to cooperate in such investigations, and release those parties supplying such information to Adams Manufacturing from all liability or responsibility with respect to information supplied or obtained.

I agree that Adams Manufacturing may use the informaiton it obtains concerning me in the conduct of its business. I understand that such use may include disclosure outside of Adams Manufacturing in those cases where its agents and contractors need such information to perform their functions, where Adams Manufacturing’s legal interests and/or obligations are involved, or where there is a medical emergency involving me. I understand, however, that Adams Manufacturing intends to protect the confidentiality of personal information it obtains concerning me. Consequently, personal information in Adams Manufacturing record keeping systems, other than the fact and location of past or present Company employment, the dates of employment, or the job name or description of general duties will not otherwise be disclosed outside of Adams Manufacturing with a personal identifier without my consent. Further, Adams Manufacturing will require its agents and contractors to safeguard personal information disclosed to them by Adams Manufacturing.

I understand that any employment with Adams Manufacturing would not be for any fixed period of time and that, if employed, I may resign at amy time for any reson or Adams Manufacturing may terminate my employment at any time for any reason in the absence of a specific written agreement to the contrary.

I understand that any false answers or statements made by me on this application or any supplemet thereto or in connection with the above mentioned investigations will be sufficient grounds for immediate discharge, if I am employed.


Acceptance of Drug Testing


Invitation to Self-Identify

Adams Mfg. Corp is a company subject to Executive Order 11246, as amended. In accordance with the Executive Order, we will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin.

Adams Mfg. Corp has a policy to ensure that all employees, as well as applicants for employment, are treated fairly, with dignity and personal respect. Adams Mfg. Corp will not discriminate in any form because of race, religion, color, sex, national origin, marital status, sexual orientation, physical or mental disability, or Vietnam Era or “Other” Veteran status.

Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Information you submit will be kept confidential, except that Government officials engaged in enforcing laws administered by OFCCP may be informed. The information provided will be used only in ways that are not inconsistent with Executive Order 11246, as amended.

Adams Manufacturing