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Application for Employment

Port Erie Plastics is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status. This application for employment is good for 6 months only. Consideration for employment after 6 months requires a new application.

Fields with (*) are required.


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Yes    No
Yes    No

(If offered employment, you will be required to provide documentation to verify eligibility.)

Yes    No

(A conviction will not necessarily disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)


  Name & Address Highest Grade Completed
Elementary School 1   2  3    4    5    6    7    8
High School 9    10   11    12
College or University 1    2    3    4


Yes    No
Yes    No
Yes    No
Yes    No
Name  Relationship


Yes    No





I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Port Erie Plastics to verify their accuracy and to obtain reference information on my work performance. I hereby release Port Erie Plastics from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of Port Erie Plastics. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or Port Erie Plastics may terminate my employment at any time with or without notice of cause.


I have read Port Erie Plastics’ Drug and Alcohol Abuse Policy. I understand that I have been asked by the Company to submit a sample of my urine for chemical analysis pursuant to the Policy. I further understand that the purpose of this analysis is to determine the presence or absence of illegal drugs.

I consent freely and voluntarily to the Company’s request for this specimen. I hereby release and hold harmless the Company and its employees and agents from any liability whatsoever arising from this request to furnish my specimen and the testing of my specimen.

I also hereby consent to the testing laboratory providing to the Company the results of the test.

I fully understand that a positive test result will result in immediate termination from Port Erie Plastics.

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Any documentation that you wish to include with your application can be attached here:

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Port Erie Plastics Is A Non Smoking Facility