AGC Employment Application

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Using this form…

If you would like to simply tell us of your interest in an available opportunity, simply go to this page for a shorter form, or click proceed below to start a complete application for submission.

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If submitting the entire application, please complete and sign on last page of this form. An incomplete application may affect your consideration for employment. Simply entering “SEE RESUME” is not a sufficient response to any question.

AGC is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin, sex, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. 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 terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on AGC. Please inform the company's personnel representative if you need assistance completing any forms or to otherwise participate in the application process.

There are "Required" items on this form. These items are noted with a small red asterisk (*). In addition, should one overlook a required item, you will be alerted when attempting to submit the form.

Personal Information

Today's Date

Position in which you are interested?*

Your Desired Compensation/Salary*

It seems as though your requested salary is incorrect. Please go back to "Your Desired Compensation/Salary" and enter your actual desired compensation/salary.

Your name*

First Last

Email*

Your Address

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

Home Phone

Cell Phone

Resume Upload

Accepted file types: pdf, txt, doc, docx, Max. file size: 128 MB.

Please upload your resume here. Acceptable formats as follows:

PDF
Word Doc (doc, docx)
Text file (.txt)

Shift Desired*

Date Available*

Hidden

Salary Desired*

Type of Employment Desired

Full-time

Part-time

Temporary

Depending on AGC location to which you're applying, are you legally authorized to work in the United States or Canada?*

(Consistent with federal law, if hired, verification will be required.)

Yes

Do you now, or will you in the future, require immigration sponsorship for work authorization (e.g., H-1B)?*

(Consistent with federal law, if hired, verification will be required.)

Yes

Education Information

High School

Name and Location of High School

Diploma or Degree (Credits earned of no degree)

Did Not Attend

Business, Trade, Technical School

Level

Name and Location of School

Diploma or Degree (Credits earned of no degree)

Major

Did Not Attend

College, Graduate School or Other

Click on the + sign to create a new row for each level of education, ie:

College**
Graduate School**
Other*

Level

Name and Location of School

Diploma or Degree (Credits earned of no degree)

Start Date Mo/Yr

End Date Mo/Yr

Major

Did Not Attend

*If GED was earned, please provide the date.

**If a degree was received under a name other than that listed on this application, please provide your full name at the time the degree was awarded

Degree

Name at Time Earned

Scholastic Achievements:

Skills and Qualifications

Summarize specific skills and qualifications acquired from employment or other experiences that are related to the position for which you are applying (e.g., computer skills, software applications, and foreign languages):

Employment History

Please provide a COMPLETE employment history, even if a resume is submitted with this application. List ALL employers, assignments, or volunteer activities that are relevant to the job for which you are applying, starting with the most recent, including military employment. Explain any gaps in employment in the “Comments” section below. Please use the “Employment History Continuation Sheet” if additional space is needed.

Company Name (Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Title

Immediate Supervisor Name & Title

Type of Employment

Full-time

Part-time

Temporary

Other

Dates Employed

Make sure to enter your date in mm/dd/year fashion.

From

Starting Hourly Rate/Salary

per

Final Hourly Rate/Salary

per

Summarize the nature of the work performed and job responsibilities.

Reason for leaving or why you are considering leaving?

If currently employed, may we contact for reference?

Yes

Did you have another job before this one?

Yes

Company Name (Second Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Job Title

Immediate Supervisor Name & Title

Type of Employment

Full-time

Part-time

Temporary

Other

Dates Employed

Make sure to enter your date in mm/dd/year fashion.

From

Starting Hourly Rate/Salary

per

Final Hourly Rate/Salary

per

Summarize the nature of the work performed and job responsibilities.

Reason for Leaving?

May we contact this employer?

Yes

Would you like to list another previous job?

Yes

Company Name (Third Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

Make sure to enter your date in mm/dd/year fashion.

From

Job Title

Immediate Supervisor Name & Title

Type of Employment

Full-time

Part-time

Temporary

Other

Starting Hourly Rate/Salary

per

Final Hourly Rate/Salary

per

Summarize the nature of the work performed and job responsibilities.

Reason for Leaving?

May we contact this employer?

Yes

Would you like to list a 4th job?

Yes

Company Name (Fourth Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

Make sure to enter your date in mm/dd/year fashion.

From

Job Title

Immediate Supervisor Name & Title

Type of Employment

Full-time

Part-time

Temporary

Other

Starting Hourly Rate/Salary

per

Final Hourly Rate/Salary

per

Summarize the nature of the work performed and job responsibilities.

Reason for Leaving?

May we contact this employer?

Yes

Comments

COMMENTS

(including an explanation for gaps in employment)

References

List at least three business/work references that are NOT related to you, and are NOT previous supervisors. If not applicable, list three school or personal references that are not related to you. A telephone number is required for all references.

Click +sign to add additional references.

Name

Telephone

Years Known

In what capacity did this person observe you or your work?

Professional Licenses and Certifications

List any professional license(s) and Certifications that are related to the position for which you are applying and list state(s) in which licensed:

Memberships

List professional, trade, business, or civic associations that you consider relevant to the position for which you are applying (exclude information that would reveal race, color, religion, creed, national origin, sex, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances). Click on the + sign to create a new row.

Organization

Offices Held

Special Accomplishments, Publications, and Awards

Exclude information that would reveal race, color, religion, creed, national origin, sex, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances.

Other Information

Are you bound by any non-solicitation/non-compete agreement?

Yes

Have you ever interviewed with and/or worked for AGC or any of its affiliated companies, either directly or through another person, party, or company?

Yes

If yes to the above, when and where.

When?

Where?

If you have ever previously worked for AGC or any affiliated company, either directly or through another person, party, or company, please list your dates of service and the reason for separation/termination.

Are any relatives or friends currently employed at AGC Glass Company North America?*

Yes

If yes to the above

Name of Employee

Business Unit where employed

What prompted your application to AGC Glass Company North America?

Ad/Posting

Friend

AGC Employee

Please enter the name of ad/posting/friend/employee

Hidden

Additional Information

Are you available to work shift work (i.e., consecutive 8 or 12 hours)?

Yes

Please Read Before Signing

APPLICANT’S CERTIFICATION AND AGREEMENT*

PLEASE READ CAREFULLY

In accepting employment with AGC Glass Company North America (the “Company”), I understand that the Company does not offer specific terms of employment unless expressly stated in a written contract for employment. I understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent and may be terminated at will, with or without cause, by either the Company or me, without prior notice to the other, unless otherwise prohibited by law.

I understand that no representation, whether oral or written, by any representative or agent of the Company, at any time, can constitute an implied or express contract of employment. I further understand no representative or agent of the Company has the authority to enter into an agreement for employment for any specified period of time or to make any change in any policy, procedure, benefit or other terms or condition of employment other than in a document signed by the Director of Human Resources or an authorized representative.

I give the Company the right to investigate all references and to secure additional information about me. I release any and all of my references and former employers from any liability for any damage due to releasing information regarding me. I understand that this application is valid for six (6) months from the date listed on page 1 and that I must re-apply after that time if I wish to remain considered for employment.

I certify that all of the above information is true and complete, and I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination regardless of the time elapsed before discovery.

An offer of employment is conditioned upon complying with the Company’s requirements including, but not limited to, signing a separate disclosure and consent form prior to any background investigation. An offer of employment is also contingent upon satisfactorily passing the Company’s physical examination and/or drug screen, and upon the applicant’s ability to be bonded, if required, by the Company’s fidelity bond carrier.

I certify

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

Entering your name here as well as the security Captcha will confirm you're a human.

First Middle Last

Date

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