Careers

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Employment Application

Date of Application*

Position(s) Applied For*

Referral Source*

Advertisement

Friend

Relative

Walk-In

Employment Agency

Other

Last Name*

First Name*

Middle Name*

Phone*

Email*

Skype

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you over 18?*

Yes

No

Have you filled out an application here before?*

Yes

No

If yes, give date

Have you ever been employed here before?*

Yes

No

If yes, give date

Are you employed now?*

Yes

No

May we contact your present employer?*

Yes

No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*

Yes

No

(Proof of citizenship or immigration status may be required upon employment)

On what date would you be available for work?*

Are you available to work?*

Full-time

Part-time

Shift work

Temporary

Are you a lay-off and subject to recall?*

Yes

No

Can you travel if your job requires it?*

Yes

No

Have you been convicted of a felony in the past 7 years?*

Yes

No

(Conviction will not necessarily, disqualify, applicant from employment)

If yes, please explain?*

Veteran of US military service?*

Yes

No

If yes, what branch?

Indicate any languages that you speak read or write.

Speak

Fluency

Fluent

Good

Fair

Read

Fluency

Fluent

Good

Fair

Write

Fluency

Fluent

Good

Fair

List professional, trade, business, or civic activities and offices held

(You may exclude those which indicate race, color, religion, sex or national origin)

References

Reference #1*

First Name Last Name

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Relationship*

Reference #2*

First Name Last Name

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Relationship*

Reference #3*

First Name Last Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Relationship*

Special Employment Notices to Disable Veterans, Vietnam Era Veterans, and Individuals With Physical or Mental Handicaps.

Government contractors are subject to 38 USC 2012 of the veteran era veterans readjustment act of 1974 which requires that they take affirmative action to employ and advance employment qualified disabled veterans and veterans of Vietnam era, and section 503 of the rehabilitation Act of 1973 as amended which requires government contractors to take affirmative action to employ and advance in employment qualified handicapped individuals.

If you are a disable veteran, or have a physical handicap, you are invited to volunteer this information. The purpose is to provide information regarding proper placement and appropriate accommodations to enable you to perform the job to the best of your ability in a proper and safe manner. This information will be treated as confidential. Failure to provide this information will not jeopardize or adversely affect your consideration for employment.

If you wish to be identified, please check box below.

Handicapped Individual

Disabled Veteran

Vietnam Era Veteran

Employment Experience

Start with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate race, color, religion, sex or national origin.

Employer #1*

Date Employed From*

Date Employed To*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Job Title*

Supervisor*

Work Performed*

Employer #2*

Date Employed From*

Date Employed To*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Job Title*

Supervisor*

Work Performed*

Employer #3*

Date Employed From*

Date Employed To*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Starting Hourly Rate/Salary*

Ending Hourly Rate/Salary*

Job Title*

Supervisor*

Work Performed*

Employer #4

Dates Employed: From

Dates Employed: To

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Starting Hourly Rate/Salary

Ending Hourly Rate/Salary

Job Title

Supervisor

Work Performed

Education

Elementary*

Highest Grade Completed*

High School*

Highest Grade Completed*

Describe course of study:*

Did you receive a diploma?*

Yes

No

College/University

Years Completed

Describe course of study:

Did you receive a degree?

Yes

No

Describe specialized training, apprenticeship, skills, and extra Curricular Activities

Honors Received

State any additional information you feel may be helpful to us in considering your application.

For Shop Applicants Only

Rate yourself on a scale of 1-10: 1-3 Good, 4-7 Average, 8-10 poor

English Spoken*

Mechanical Ability*

Mathematical Ability*

English Reading*

Working with others*

Blueprint Reading Ability*

English Writing*

Electrical Ability*

Welding Ability*

Do you have experience with computers?*

Yes

No

Do you have experience with calculators?*

Yes

No

Applicant's Statement

Comments

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