Employment Application

First Name

Last Name

Street Address

Apartment/Unit #

City

State

ZIP Code

Phone

Email

Date Available:

Social Security No.:

Desired Wage/ Salary:

Position Applied for:

Are you able to fulfill all of the tasks required to fulfill this job? The tasks required to fulfill this job include but are not limited to the following: lifting greater than 50 lbs; walking and climbing stairs in work boots up to 16 hours per day, up to 70 hours week; working in confined spaces; lawful and safe driving of company vehicles; safe use of a respirator; working at heights greater than 4 stories; working with a variety of paints and solvents; maintaining composure under stressful situations; working well with others; reading, written communications, oral communications: Are you able to fulfill all of the tasks required to fulfill this job? The tasks required to fulfill this job include but are not limited to the following: lifting greater than 50 lbs; walking and climbing stairs in work boots up to 16 hours per day, up to 70 hours week; working in confined spaces; lawful and safe driving of company vehicles; safe use of a respirator; working at heights greater than 4 stories; working with a variety of paints and solvents; maintaining composure under stressful situations; working well with others; reading, written communications, oral communications: Yes no

Only U.S. Citizens or aliens who have the right to work in the U.S are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity? Only U.S. Citizens or aliens who have the right to work in the U.S are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity? Yes no

Have you ever worked for this company? Have you ever worked for this company? Yes no

When?

Have you ever been convicted of a felony? Have you ever been convicted of a felony? Yes no

Explain:

High School:

Address:

From:

To:

Did you graduate? Did you graduate? Yes No

Diploma:

College:

Address:

From:

To:

Did you graduate? Did you graduate? Yes No

Degree:

Other:

Address:

From:

To:

Did you graduate? Did you graduate? Yes No

Degree:

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Full Name:

Relationship:

Company:

Phone:

Address:

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference? May we contact your previous supervisor for a reference? Yes No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference? May we contact your previous supervisor for a reference? Yes No

Company:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From:

To:

Reason for Leaving:

May we contact your previous supervisor for a reference? May we contact your previous supervisor for a reference? Yes No

Branch:

From:

To:

Rank at Discharge:

Type of Discharge:

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Rank (1-5)

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Rank (1-5)

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Signature:

Date: