Application

Position(s) Applied For

Date of Application

First Name

Middle Name

Last Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Email Address

2.If you are under 18 years of age, can you provide required proof of your eligibility to work?YesNo

3.Have you ever filed an application with us before?YesNo

If Yes, give date.

4.Have you ever been employed with us before?YesNo

If Yes, give date.

5.Do any of your friends or relatives, other than spouse, work here?YesNo

6.Are you currently employed?YesNo

7.May we contact your present employer?YesNo

8.Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Proof of citizen or immigration status will be required upon employment.YesNo

9.Date available for work

10.What is your desired salary range?

11.Are you available to work:

Full Time:Part Time:

Full time Shift

First ShiftSecond ShiftThird Shift

Part time shift

First shiftSecond ShiftThird Shift

12.Are you currently in "lay-off" status and subject to recall?YesNo

13.Can you travel if the job requires it?YesNo

Form Section

Education

Name of High School

Course of Study

Number of Years Completed

Name of Undergraduate College

Course of Study

Number of Years Completed

Name of Graduate Professional

Course of Study

Number of Years Completed

Other(Specify)

Course of Study

Number of Years Completed

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Describe any job-related training received in the United States military.

EMPLOYMENT EXPERIENCE

1. Employer

Address

Phone

Job Title

Supervisor

Dates Employed From

Dates Employed To

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Reason for Leaving

Work Performed

2. Employer

Address

Phone

Job Title

Supervisor

Dates Employed From

Dates Employed To

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Reason for Leaving

Work Performed

3. Employer

Address

Phone

Job Title

Supervisor

Dates Employed From

Dates Employed To

Hourly Rate/Salary Starting

Hourly Rate/Salary Final

Reason for Leaving

Work Performed

ADDITIONAL INFORMATION

Summarize special job-related skills and qualifications acquired from employment or other experience.

WMP(per minute)

Production/Mobile machinery(list)

Other(list)

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

REFERENCES

Name

Phone

Email Address

Name

Phone

Email Address

Name

Phone

Email Address

I&M Machine and Fabrication