Web Site First Name * Middle Last Name * Email Address * Phone Number * Are you 18 years or older? * Yes No Are you prevented from lawfully becoming employed in this country because of visa or immigration status? Yes No Current Address Street * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Is your Permanent Address the same as your Current Address Above? * Yes No Employment Desired Position * Date you can start * Salary Desired * Are you employed now? * If yes, may we contact your current employer? * Have you ever applied to this company before? * Yes No If you were referred here by anyone please provide their name below. Education Elementary & Middle School School Name(s) Location(s) Number of Years Attended Did you graduate? Yes No High School School Name Location Number of Years Attended Did you graduate? Yes No College Did you attend college? Yes No Trade, Business or Correspondence School Did you attend trade, business or correspondence school? Yes No General Subjects of special study or research work Special Skills Activities (Civic, Athletic, Etc.) Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members. Have you served in the U.S. Military or Naval Service? Yes No Former Employers Employer Name (Most Recent) * Employer Address Street * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * From * Please enter month and year you began work with this employer. To * Please enter month and year you ended work with this employer. Salary Position * Reason for Leaving * Employer Name (2) Employer Address Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip From Please enter month and year you began work with this employer. To Please enter month and year you ended work with this employer. Salary Position Reason for Leaving Employer Name (3) Employer Address Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip From Please enter month and year you began work with this employer. To Please enter month and year you ended work with this employer. Salary Position Reason for Leaving Employer Name (4) Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip From Please enter month and year you began work with this employer. To Please enter month and year you ended work with this employer. Salary Position Reason for Leaving Which of these jobs did you like best? * What did you like most about this job? * References Give the names of three persons not related to you, whom you have known at least one year. Reference 1 First Name Last Name Business Years Acquainted Phone Reference 2 First Name Last Name Business Years Acquainted Phone Reference 3 First Name Last Name Business Years Acquainted Phone In Case of Emergency Notify First Name Last Name Phone Number Applicant Questionnaire If you have experience in any of the following areas please check them off below. Oxygen Acetylene Burning Farm Work Forklift Operator Machine Operator Overhead Crane Truck Driving Maintenance Drill Press Janitorial Welding Fitting Please answer Yes or No to the questions below. Are you willing to work overtime? * Yes No Are you willing to work shift work? * Yes No Do you have reliable transportation? * Yes No Can you do simple math? * Yes No Are you willing to voluntarily submit to pre-employment drug and alcohol test? * Yes No Please Verify * I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED. MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE. AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.
