Personal Information    
  How were you referred to us:  
  *  Available Positions (Please Choose)
sales 
production assistant production assistant
electrical engineer
estimator
electrical technician
mechanic assembler
planner
fabricator
machinist
tig welder
painter
delivery
shop floor cleaner
shipping - receiving
other

 
  Date:
  Full Name:
  Address:
  City:
  State:
  Zip:
  Your eMail:
  Phone:
  Mobile/Other:
  18 Years or Older:
  If NO, please explain:
   
  Social Security #
  Requirements:
  Date You Can Start:
  Salary Expectations:
  Worked here before:
  If YES, When:
  Citizen - United States?
  If NO, legally allowed?
  Type of employment:


  Ever been convicted ?
  If YES, give dates/details:
Answering "yes" to this question does not constitute an automatic rejection for employment. Date of the offense, seriousness, and nature of the violation, rehabilitation and position applied for will be considered.

Summarize Your Special Skills or Qualifications:
   
    Education
School

Name and Location of School

Course of Study

No. Years Completed

Did You Graduate?

 Degree/ Diploma  
Graduate       
College       
Business/Trade/Technical       
High School       
Elementary       

 
    Previous Employment (begin with most recent position):
Dates of Employment: From:   To:   
Positions(s) Held:
Firm / Company: 
Address of Employer:  
Phone Number:  
Supervisor:  
Title of Supervisor:  
Your Responsibilities:  
Starting Salary & Title:  
Ending Salary and Title:  
Reason for Leaving:  
May we contact this employer for reference ? Yes     No  
     
    Previous Employment
Dates of Employment: From:   To:   
Positions(s) Held:
Firm / Company: 
Address of Employer:  
Phone Number:  
Supervisor:  
Title of Supervisor:  
Your Responsibilities:  
Starting Salary & Title:  
Ending Salary and Title:  
Reason for Leaving:  
May we contact this employer for reference ? Yes     No  
     
    Previous Employment
Dates of Employment: From:   To:   
Positions(s) Held:
Firm / Company: 
Address of Employer:  
Phone Number:  
Supervisor:  
Title of Supervisor:  
Your Responsibilities:  
Starting Salary & Title:  
Ending Salary and Title:  
Reason for Leaving:  
May we contact this employer for reference ? Yes     No  
     


APPLICANT'S STATEMENT

AUTHORIZATION

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

 


I agree to the AUTHORIZATION

       

 
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