Fillable Printable Goodyear Application Form
Fillable Printable Goodyear Application Form
Goodyear Application Form
EMPLOYMENT APPLICATION
The Goodyear Tire & Rubber Company is an Equal Opportunity Employer.
The Goodyear Tire & Rubber Company does not discriminate in employment on the basis of race, color, religion, sex, sexual orientation,
national origin, age, disability, veteran status, or any other characteristic prohibited by applicable Federal, State or local law.
Personal Information
NAME
First Name:JayLast Name:Imerman
Middle Name:JosephName-Suffix:
Preferred Name:
Date of Application:Apr 16, 2013
PREVIOUS NAME(S) (Include maiden name)
First Name:
Last Name:
Middle Name:
Date(s) of change:
(MM/YYYY)
PRESENT ADDRESS
Mailing Address:
Country:United States
Street:4067 Highview Court
City:WaterfordState:MichiganZip:48329
Telephone No.:248.230.4373Cell Phone No.:
Email Address:jimerman@gmail.com
PERMANENT ADDRESS
Mailing Address:
Street:
City:
State:
Zip:
Core Questions
Are you 18 years of age or older?
Yes
How did you hear about The Goodyear Tire & Rubber Company?
Have used their products on my vehicles for years
Date available to begin work?
Jun 17, 2013
Approximate salary expected: (If applying for an hourly position, please provide expected hourly rate; if applying for a salaried position,
please provide expectation annual salary)
150,000 (You must enter a dollar amount; Negotiable will not acceptable)
Type of work desired?
Full time
Terminations/Convictions
In the last seven years, have you been involuntarily terminated (fired) (or resigned in lieu of being terminated) from any employment
relationship? The questions seeking information on criminal convictions should NOT be answered by Massachusetts or Hawaiian applicants
in any state where such questions are prohibited.
Yes
Where:
RAND Worldwide
Reason:
RAND closed their PLM division and laid off all employees in that business.
Have you
EVER
been convicted of or pleaded guilty to any crime other than minor traffic offenses?
No
If yes, list city, state, date and what offense for all:
FAILURE TO PROVIDE A COMPLETE AND ACCURATE RESPONSE WILL BE CONSIDERED FALSIFICATION AND PREVENT YOU
FROM BEING EMPLOYED AT The Goodyear Tire & Rubber Company. IF YOU HAVE ANY QUESTION ABOUT WHETHER AN OFFENSE
SHOULD BE DISCLOSED, PLEASE ASK.
U.S. Military Background
Former Employee
Are you a former employee of The
Goodyear Tire & Rubber Company?
NoJob Title:
Business Unit:
Last Location:
From:
To:
Reason for leaving:
Driver's License
Do you currently have a valid driver's
license?
YesState:Michigan
DL Number:I565379441376Expiration Date:May 18, 2016
Do you currently have a valid CDL?NoState:
CDL Number:
Expiration Date
Previous Employers (1)
ACCOUNT FOR ALL YOUR TIME -- REGARDLESS OF HOW SPENT (INCLUDING MILITARY, EDUCATION, SELF EMPLOYMENT, UNEMPLOYMENT AND
PREVIOUS WORK WITH THE COMPANY.)
Present or Past employer:PresentCompany Name:Inceptra LLC
Employer Type:All other typesPosition Type:Direct Hire
Address:
Country:United StatesStreet:2020 Northwest 150th Avenue
City:Pembroke PinesState:FloridaZip:33028
Reference Name:N/APhone No.:(954) 442-5400
Start Month: (Enter 2 digits: MM)04
Start Year: (Enter 4 digits:
YYYY)
2010
End Month: (Enter 2 digits: MM)
End Year: (Enter 4 digits:
YYYY)
Title:Senior PLM Solutions ArchitectJob Duties:
Reason for leaving job (if not
a present employer, please explain):
Supervisor:Dan J. Smith
May we contact this
employer:
No
Starting Salary:110000Ending Salary:134000
Previous Employers (2)
ACCOUNT FOR ALL YOUR TIME -- REGARDLESS OF HOW SPENT (INCLUDING MILITARY, EDUCATION, SELF EMPLOYMENT, UNEMPLOYMENT AND
PREVIOUS WORK WITH THE COMPANY.)
Present or Past employer:PresentCompany Name:JLI Enterprises LLC
Employer Type:Self employeedPosition Type:Direct Hire
Address:
Country:United StatesStreet:4067 Highview Court
City:WaterfordState:MichiganZip:48329
Reference Name:Jay imermanPhone No.:2482304373
Start Month: (MM)05Start Year: (YYYY)1997
End Month: (MM)
End Year: (YYYY)
Title:PresidentJob Duties:
Reason for leaving job (explain):
Supervisor:Nobody
May we contact this
employer:
Yes
Starting Salary:N/AEnding Salary:N/A
Previous Employers (3)
Previous Employers (4)
ACCOUNT FOR ALL YOUR TIME -- REGARDLESS OF HOW SPENT (INCLUDING MILITARY, EDUCATION, SELF EMPLOYMENT, UNEMPLOYMENT AND
PREVIOUS WORK WITH THE COMPANY.)
Present or Past employer:NACompany Name:
Employer Type:
Position Type:
Address:
Country:
Street:
City:
State:
Zip:
Reference Name:
Phone No.:
Start Month: (MM)
Start Year: (YYYY)
End Month: (MM)
End Year: (YYYY)
Title:
Job Duties:
Reason for leaving job (explain):
Supervisor:
May we contact this
employer:
Starting Salary:
Ending Salary:
Previous Employers (5)
ACCOUNT FOR ALL YOUR TIME -- REGARDLESS OF HOW SPENT (INCLUDING MILITARY, EDUCATION, SELF EMPLOYMENT, UNEMPLOYMENT AND
PREVIOUS WORK WITH THE COMPANY.)
Present or Past employer:NACompany Name:
Employer Type:
Position Type:
Address:
Country:
Street:
City:
State:
Zip:
Reference Name:
Phone No.:
Start Month: (MM)
Start Year: (YYYY)
End Month: (MM)
End Year: (YYYY)
Title:
Job Duties:
Reason for leaving job (explain):
Supervisor:
May we contact this
employer:
Starting Salary:
Ending Salary:
Previous Employers (6)
ACCOUNT FOR ALL YOUR TIME -- REGARDLESS OF HOW SPENT (INCLUDING MILITARY, EDUCATION, SELF EMPLOYMENT, UNEMPLOYMENT AND
PREVIOUS WORK WITH THE COMPANY.)
Present or Past employer:NACompany Name:
Employer Type:
Position Type:
Address:
Country:
Street:
City:
State:
Zip:
Reference Name:
Phone No.:
Start Month: (MM)
Start Year: (YYYY)
End Month: (MM)
End Year: (YYYY)
Title:
Job Duties:
Reason for leaving job (explain):
Supervisor:
May we contact this
employer:
Starting Salary:
Ending Salary:
JayImerman
1206886 - IT-Product Lifecycle Management Application Development Architect Enovia - Akron Tech Center [N101] - 0014
Previous Employers (7)
ACCOUNT FOR ALL YOUR TIME -- REGARDLESS OF HOW SPENT (INCLUDING MILITARY, EDUCATION, SELF EMPLOYMENT, UNEMPLOYMENT AND
PREVIOUS WORK WITH THE COMPANY.)
Present or Past employer:NACompany Name:
Employer Type:
Position Type:
Address:
Country:
Street:
City:
State:
Zip:
Reference Name:
Phone No.:
Start Month: (MM)
Start Year: (YYYY)
End Month: (MM)
End Year: (YYYY)
Title:
Job Duties:
Reason for leaving job (explain):
Supervisor:
May we contact this
employer:
Starting Salary:
Ending Salary:
Education
CHOOSE HIGHEST SCHOOL YEAR COMPLETED
High School:12College:4
Business:
Trade School:
Graduate School:
HIGH SCHOOL
Name:West Bloomfield High SchoolLocation: (City, State/Province/Country)West Bloomfield, MI
Status of Degree:Degree/GED completed
POST HIGH SCHOOL EDUCATION
Name:University of MichiganLocation: (City, State/Province/Country)Dearborn, MI
From: (MM/YYYY)09/1990To: (MM/YYYY)12/1993
Type of Degree:BSStatus of Degree:Degree Completed
GPA:3.8Major:Computer Science
POST HIGH SCHOOL EDUCATION
Name:
Location: (City, State/Province/Country)
From: (MM/YYYY)
To: (MM/YYYY)
Type of Degree:
Status of Degree:
GPA:
Major:
POST HIGH SCHOOL EDUCATION
Name:
Location: (City, State/Province/Country)
From: (MM/YYYY)
To: (MM/YYYY)
Type of Degree:
Status of Degree:
GPA:
Major:
LIST LANGUAGES OTHER THAN ENGLISH (Separate each language with a comma)
Speak:French, German, Hebrew
Read:
Write:
References
BUSINESS/PROFESSIONAL REFERENCES RELATED TO PREVIOUS EMPLOYMENT (non relative)
First
Name:
See CVLast Name:See CV
Address:
Street:See CV
City:See CVState:MichiganZip:See CV
Country:United States
Company:See CVPosition:See CV
Phone
No.:
See CVLength of Acquaintance:See CV
First
Name:
See CVLast Name:See CV
Address:
Street:See CV
City:See CVState:MichiganZip:See CV
Country:United States
Company:See CVPosition:See CV
Phone
No.:
See CVLength of Acquaintance:See CV
JayImerman
1206886 - IT-Product Lifecycle Management Application Development Architect Enovia - Akron Tech Center [N101] - 0014
Certification By Applicant
I hereby apply for a position with The Goodyear Tire & Rubber Company and grant said company permission to contact any person,
company or school listed herein or orally given as reference to request information regarding my application for employment. I release any
such person, company or school from any and all liability on account of furnishing such information. I understand that my misrepresentation
of the information provided herein or on any other documentation provided to The Goodyear Tire & Rubber Company shall constitute just
cause for termination of the interview process or, if applicable, continued employment without prior notice.
I understand that any employment pursuant to this application shall be subject to my passing the standard physical examination which
includes drug testing for evidence of drug abuse as a condition of final acceptance for employment. I further understand that such
employment is subject to receiving and retaining any required security clearance. I understand that any employment pursuant to this
application is provided without any representation or commitment for unlimited employment.
Employment Status Statement
I hereby agree and affirmthat no promises or commitments regarding tenure of employment may be made to me by any personnel of The
Goodyear Tire & Rubber Company. I am voluntarily seeking employment with The Goodyear Tire & Rubber Companyand I understand I am
free to resign. Similarly, The Goodyear Tire & Rubber Company is free to conclude my employment at anytime with or without cause. I
understand that established employment policies and practices or employer pension, welfare and benefit programs of the Company are
subject to modification or elimination at the discretion of the Senior Vice President, Human Resource or his/her success or designated
Human Resource Division agents. Furthermore, I understand no other personnel of The Goodyear Tire & Rubber Company have the
authority to make any representations that establish any specific period of employment, or conflict with, deviate from or are inconsistent with
such personnel or benefit matters. I further understand that any employment pursuant to this application is conditioned upon my providing
proof of lawful authorization to work in the United States.
Disclosure Statement
I understand that The Goodyear Tire & Rubber Company is unwilling to employ me unless I first fully disclose to it certain information. This
includes all current agreements I may have with my prior employers or other relating to any of the following: 1. Restrictive covenants
(promises not to compete, etc.); 2. Confidential information or trade secrets of others; 3. Inventions or patents; 4. Computer code I have
written; or 5. Copyrights to my works or writings. I certify that I have provided The Goodyear Tire & Rubber Companywith copies or full
written descriptions of all such agreements having any provisions still in effect. I further certify that I have not made any other agreements
that could adversely affect The Goodyear Tire & Rubber Company business or legal interests regarding the items listed above.
I understand that the content or scope of any such agreement may affect The Goodyear Tire & Rubber Company willingness to employ me.
Failure by me to have fully disclosed any of such agreements The Goodyear Tire & Rubber Company may believe to be significant shall be
cause for The Goodyear Tire & Rubber Companyto terminate my employment. I understand that unless or until a final offer of employment is
made, I should not take any action which could result in financial loss if a contingent offer is withdrawn, such as giving notice of intent to
terminate current employment, selling real estate, or incurring any other costs associated with accepting employment with The Goodyear
Tire & Rubber Company. No such activity should be undertaken until after medical clearance and notification of a successful background
investigation has been received and I receive a final offer of employment.
Acknowledgement
I have read and fully understand the information and the questions in this application. To the best of my knowledge, all the information listed
on this application and accompanying material, if any, is complete, true, and accurate. I understand that any incomplete or false statements,
misrepresentations, or omissions of fact may disqualify me for employment or, if I am hired, may result in termination of my employment
without notice.
After submitting your application, if you wish to withdraw your consent or you wish to obtain a copy of your application, you can contact us
toll-free at 866-713-0051.
Electronic Signature (Enter your name first and last exactly as you
entered it in the personal information section of the application):
Jay Imerman
I authorize my Electronic Signature:Accepted
Date:Apr 16, 2013
Consumer Authorization
I hereby authorize and request The Goodyear Tire & Rubber Company and its designated representatives and agents, any consumer
reporting agency or others having knowledge concerning my criminal conviction history, driving history, professional or business references,
education verification, employment verification and identity verification (social security number verification) to furnish bearer with such
information in connection with an application for employment. I am willing that a photocopy of this authorization be accepted with the same
authority as the original, and I specifically waive any written notice from those who may provide information based upon this authorization
request.
I have been given a stand-alone consumer authorization form that a report may be requested for the reason shown above.
Electronic Signature (Enter your name first and last exactly as you
entered it in the personal information section of the application):
Jay Imerman
I authorize my Electronic Signature:Accepted
