Last Name  First Name    Middle Initial

Present Address
Street City   State Zip Code
How Long   Years   Months

Home Phone No. --   Best time to call you at home is   

Email Address    Home       Work

Work Phone No. -- May we contact you at work? Yes  No
Best time to call at work?

Former Address
Street City   State Zip Code
How Long   Years   Months

How soon could you be available for work?

Are you 18 years of age or older?     Yes      No

Have you ever been convicted of a felony?   Yes      No     

If yes, give details

A conviction record will not necessarily be a bar to employment, and factors such as age and time of the offense, the seriousness and nature of the violation, and the applicant’s rehabilitation will be considered in the hiring decision.

Are you legally eligible for employment in this country?       Yes       No 

(Proof of right to work will be required upon employment of a non U.S. Citizen.)

 EMPLOYMENT DESIRED

Position Desired:
First Choice           
Second Choice

Shift Preference:    First     Second     Third     Weekend 
Rate of pay expected

Have you worked for this company before?     Yes        No
If yes, when?   From (month/year) To  (month/year)

Position held then  
Reason for leaving

Have you filed an application here before?    Yes       No
Give Date(s) 

 PAST EMPLOYMENT

May we contact your present employer?   Yes     No

Start with your present or most recent employment first

Employer Name
Address:
Street City   State Zip Code  
Employed From To      Rate of Pay
Name of Supervisor     Mr.       Ms. 

Work Performed

Reason for leaving

Employer Name
Address:
Street City   State Zip Code  
Employed From To      Rate of Pay
Name of Supervisor     Mr.       Ms. 

Work Performed

Reason for leaving

Employer Name
Address:
Street City   State Zip Code  
Employed From To      Rate of Pay
Name of Supervisor     Mr.       Ms. 

Work Performed

Reason for leaving

Employer Name
Address:
Street City   State Zip Code  
Employed From To      Rate of Pay
Name of Supervisor     Mr.       Ms. 

Work Performed

Reason for leaving

Employer Name
Address:
Street City   State Zip Code  
Employed From To      Rate of Pay
Name of Supervisor     Mr.       Ms. 

Work Performed

Reason for leaving

Referral Source:    Advertisement      Employee      Job   Service      Walk-In      Other
Name of Source, if applicable

MILITARY STATUS

Have you served in the United States Armed Forces?    Yes    No
Dates Served:  From:      Month   Year
                           To:           Month   Year

Rank at Discharge
Special Training Received

EDUCATION

Highest Grade Completed:  7th Grade Jr. High School 8th Grade Jr. High School 1st Year (Freshman) High School 2nd Year (Sophmore) High School 3rd Year (Junior) High School 4th Year (Senior) High School 1 Years Technical School 2 Years Technical School Technical Degree 1 Years of College 2 Years of College Associates Degree (2yr.) 3 Years of College 4 Years of College Bachelor's Degree 5 Years of College 6 Years of College Master's Degree Doctorate Degree PHD
Degree (Technical or Formal) in?

Place of Education:

Grade School          

Middle School         

High School             
                                    Degree/Diploma Yes No

GED  Yes   No

Vocation/Technical 
                                    Degree/Diploma Yes No                Type of Degree 

College1                   
                                    Degree/Diploma Yes No                Type of Degree 

College2                   
                                    Degree/Diploma Yes No                Type of Degree 

College1                   
                                    Degree/Diploma Yes No                Type of Degree 

Other Education       
                                    Degree/Diploma Yes No                Type of Degree 

EXPERIENCE AND QUALIFICATIONS - CLERICAL

Indicate training and experience in the following:

Type by touch?  Yes      No    If yes, Words Per Minute   Years of training/experience
Formal training?  Yes      No  If yes, where?

Word Processing  Yes      No    Years of training/experience
Brand(s) used (exmpl. Microsoft Word, Notepad, etc.)
Formal training?  Yes      No  If yes, where?

Windows based Software.  Yes      No  Years of training/experience
Formal training?  Yes      No  If yes, where?

Calculator/10 Key by touch?  Yes      No      Years of training/experience
Formal training?  Yes      No  If yes, where?

Spread Sheet Software?  Yes      No      Years of training/experience
Brand(s) used (exmpl. Microsoft Excel, etc.)
Formal training?  Yes      No  If yes, where? 

Database Software?   Yes      No      Years of training/experience
Brand(s) used (exmpl. Microsoft Access, etc.)
Formal training?  Yes      No  If yes, where?  

MRP/SAP Software?   Yes      No      Years of training/experience
Brand(s) used (exmpl. Sightline etc.)
Formal training?  Yes      No  If yes, where?  

EXPERIENCE AND QUALIFICATIONS - MANUFACTURING

Indicate training and experience in the following:

Blue Print Reading?  Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

Drafting/CAD/CAM?  Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

Calibrated Measuring Tools    Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

Mechanical Background?    Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

Tape Measure?    Yes      No
Years of training/experience   Where?

Mechanical Assembly?    Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

Electrical/Electrician?    Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

Forklift Truck?    Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

Punch Press?    Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

Welding/Torch/Plasma?    Yes      No
Years of training/experience   Where?
Formal training?  Yes      No  If yes, where?  

EXPERIENCE AND QUALIFICATIONS - SUPERVISOR / MANAGMENT

List Management Type Positions:
Where?    Title   Duties 
Number of people supervised?    Years of supervision experience there

Where?    Title   Duties 
Number of people supervised?    Years of supervision experience there

Where?    Title   Duties 
Number of people supervised?    Years of supervision experience there

Where?    Title   Duties 
Number of people supervised?    Years of supervision experience there

State any additional work information you feel may be helpful in considering your application

REFERENCES

Name:
Street  City   State
Telephone Number  --  Years Acquainted?       
Professional        Personal        Family

Name:
Street  City   State
Telephone Number  --  Years Acquainted?       
Professional        Personal        Family

Name:
Street  City   State
Telephone Number  --  Years Acquainted?       
Professional        Personal        Family