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First Name*
Last Name*
Email*
Cell Phone*
Home Phone
Are you a current employee?* YesNo
Are you able to perform the essential functions of this position, with or without reasonable accommodation?* YesNo
Do you have any relatives or household members working at Worldwide Power Products currently?* YesNo
Who?*
Are you currently under an active non-compete or similar agreement that might prevent you from being permitted to work with Worldwide Power Products?* YesNo
Work Authorization:* —Please choose an option—I am authorized to work in this country for any employer.I am authorized to work in this country for my present employer onlyI require sponsorship to work in this country.My status to work in this country is unknown
Will you now or in the future require sponsorship for employment VISA status?* YesNo
Please provide the name of the person who referred you to this role
U.S. Equal Employment Opportunity/Affirmative Action Information
In order to provide equal employment and advancement opportunities to all individuals, employment decisions at Bury will be based on merit, qualifications and abilities. Bury does not discriminate in employment opportunities or practices on the basis of race, color, ancestry, religion, sex, sexual orientation, pregnancy, national origin, age, disability, military or veteran status, or any other characteristic protected by federal, state or local law. You are being given the opportunity to provide the following information in order to help us comply with federal and state record keeping, reporting, and other legal requirements.
Please Note: Completion of this form is voluntary
Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.
Gender:* MaleFemaleDeclined to Self-Identify
Ethnicity/Race:* Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.Declined to Self-Identify
Veteran Status: —Please choose an option—VeteranNot a VeteranDeclined to Self-Identify
Veteran Type Recently Separated VeteranArmed Forces Service Medal VeteranOther Protected Veteran
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