Employment Application Home / Employment Application We are an equal employment opportunity company. We are dedicated to a policy of non-discrimination in employment on any basis including race, creed, age, sex, religion, national origin, height, weight, marital status, or disability.Applicant InformationFirst Name M.I. Last Name Birth Date MM slash DD slash YYYY Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email Address* Interview Date Availble MM slash DD slash YYYY Salary Weekday Availability: Mon. Tues. Wed. Thur. Fri. Sat. Sun. Shift Availability: 1st Shift (6:55a – 3:00p) 2nd Shift (2:55p – 11:00p) 3rd Shift (10:55p – 7:00a) Position Applied forPosition Applied forGeneral LaborFork Truck DriverMaintenanceShipping / ReceivingPaint Tech.Supervision / Group LeaderQuality AssistantOfficeSocial Security Number Are you a citizen of the United States? Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company? Yes No If yes, when? Have you ever been convicted of a felony? Yes No If yes, explain:Previous EmploymentCompany PhoneAddress Supervisor Job Title Starting Salary Ending Salary ResponsibilitiesFrom – Date MM slash DD slash YYYY To – Date MM slash DD slash YYYY Reason for LeavingCompany PhoneAddress Supervisor Job Title Starting Salary Ending Salary ResponsibilitiesFrom – Date MM slash DD slash YYYY To – Date MM slash DD slash YYYY Reason for LeavingCompany PhoneAddress Supervisor Job Title Starting Salary Ending Salary ResponsibilitiesFrom – Date MM slash DD slash YYYY To – Date MM slash DD slash YYYY Reason for LeavingEducationHigh School Address From – Date MM slash DD slash YYYY To – Date MM slash DD slash YYYY Did you graduate? Yes No Diploma Degree College Address From – Date MM slash DD slash YYYY To – Date MM slash DD slash YYYY Are you able to lift 45 pounds? Yes No Military ServiceFrom – Date MM slash DD slash YYYY To – Date MM slash DD slash YYYY Branch Rank at Discharge Type of Discharge If other than honorable, explain:Disclaimer and SignatureAre you able to lift 45 pounds? Yes No Do you have reliable transportation? Yes No How did you hear about us?If other, please explainWhy do you desire to work with our company?Disclaimer and SignatureI certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I authorize the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I agree to undergo a character investigation and I agree to take an honesty verification test in accordance with state and federal laws upon reasonable suspicion of any and all discrepancies involving my work. I understand that no representative of the company, except the president, has the authority to enter into any agreement for employment for any specified period of time, nor am I obligated to work for the company for any specified period of time. The president’s agreement must be in writing.Signature Date MM slash DD slash YYYY Note: This application will be kept for 12 months. You need to complete another to be reconsidered after this date.
