Name

Date

Address

Email

Phone

Position Applying For

Desired Salary

Date Available

Have you ever applied to this company before? Have you ever applied to this company before? Y N

If yes, when?

Days available to work Days available to work M T W Th F S S

Shifts or hours you can work: Shifts or hours you can work: Days Evenings Nights

Can you work overtime if requested? Can you work overtime if requested? Y N

Are you 18 years or older? Are you 18 years or older? Y N

Previous Employment 1

Company

Phone

Address

Job title

Starting salary

Ending salary

Responsibilities

Dates of Employment

May we contact this employer? May we contact this employer? Y N

Previous Employment 2

Company

Phone

Address

Job title

Starting salary

Ending salary

Responsibilities

Dates of Employment

May we contact this employer? May we contact this employer? Y N

Previous Employment 3

Company

Phone

Address

Job title

Starting salary

Ending salary

Responsibilities

Dates of Employment

May we contact this employer? May we contact this employer? Y N

High School

High School

Address

From

To

Did you graduate? Did you graduate? Y N

College

College

Address

From

To

Did you graduate? Did you graduate? Y N

Degree

Technical

Technical

Address

From

To

Did you graduate? Did you graduate? Y N

Degree

Skills check list 1 Skills check list 1 Reading a tape measure Reading blueprints Saw operator Iron worker operations Grinder Drill press Forklift certified Mild steel welding Stainless steel welding

continued... continued... Aluminum welding MIG welding Out-of-position welding CNC mill machine Lathe machine Plate roll operations Press brake operations Sandblasting Spray painting

Reference 1

Full name

Relationship

Company

Phone

Address

Reference 2

Full name

Relationship

Company

Phone

Address

Military service

Branch

Rank at discharge

Period of active duty - From:

To

Duties and any special training

Disclaimer Disclaimer I declare that all statements contained in this application are true and that any misrepresentation or omission may result in rejection of my application and/or termination of my employment at any time. I authorize you to conduct a criminal background check, as well as personal and professional background checks, for the purposes of consideration of this application. You may contact any references, past and current employers, and any other individual or organization that might be relevant to the position for which I am applying—except for those specifically excluded in writing on this application. I hereby release all of these references, employers and other individuals/organizations from any and all liability for damages that might occur in connection with the processing of this application. If extended an offer of employment, I understand and agree that my employment relationship with this organization is an “at-will” relationship, meaning that both the organization and I have the right to terminate this employment relationship at any time for no reason or for any reason, as long as that reason is not illegal. No verbal promises or guarantees can change this at-will relationship. Any changes to the at-will relationship or its terms must be in writing, for the agreed purpose of changing the relationship, and signed by me and by an authorized officer of this organization. (For further information, please consult this organization’s at-will policy.) This organization prohibits and does not tolerate discrimination in any form, including harassment, on the basis of race, color, national origin, religion, sex, age, veteran, familial or marital status, disability, genetics, sexual orientation, or any other protected category of individuals. This organization is an equal opportunity employer and makes hiring and other employment decisions based on job-related qualifications, abilities, and factors other than on the basis of the race, color, national origin, religion, sex, age, veteran, familial or marital status, disability, genetics, sexual orientation, or any other protected category of individuals. (For further information, please consult this organization’s EEO policy.) By checking this box, I indicate that I have read all of the above statements, that I asked any questions I may have had, and that I fully understand all of these statements.

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