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: New Field New Field New Field New Field New Field New Field New Field Rank (1-5) New Field Rank (1-5) New Field Rank (1-5) New Field Rank (1-5) New Field Rank (1-5) New Field Rank (1-5) New Field Rank (1-5) New Field Rank (1-5) New Field New Field New Field Signature: Date: 4 + 5 = Submit