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Contact
419-476-3933
Employment
Application for Employment
Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, disability, veteran status, marital status, sexual orientation, or any other characteristic protected by law. WE ARE AN EQUAL OPPORTUNITY EMPLOYER.
Last Name
*
First Name
*
Middle Name
Street Address
City
State
Zip
Length of time at this address
Phone
*
Social Security Number
Email
*
Type of work you wish to be considered for
Factory Worker
Welder
Production Machine Operator
Production Setup
Inspector
Laborer
Shipping
Administrative Assistant
Foreman
Press Brake Operator
General Manager
Sales Manager
Engineer
Grinder
Type of work you wish to be considered for
Are you able to perform the essential functions of the job you are applying for?
Yes
No
Full or Part time?
Full-time
Part-time
What source led you to make application with us?
EMPLOYMENT HISTORY
Please list your COMPLETE employment history. List present to the most recent employer first.
Present/Most Recent Employer
Employer Address/City
Name of Supervisor
Employed Dates (Mo/Yr) From:
Employed Dates (Mo/Yr) To:
Type of work performed and last job title/position
Present or last salary
Reason for leaving
Second Most Recent Employer
Second Most Recent Employer
Employer Address/City
Name of Supervisor
Employed Dates (Mo/Yr) From:
Employed Dates (Mo/Yr) To:
Type of work performed and last job title/position
Present or last salary
Reason for leaving
Third Most Recent Employer
Third Most Recent Employer
Employer Address/City
Name of Supervisor
Employed Dates (Mo/Yr) From:
Employed Dates (Mo/Yr) To:
Type of work performed and last job title/position
Present or last salary
Reason for leaving
EDUCATION
High School Name & Location
Last Year Completed
7
8
9
10
11
12
Major Courses
Diploma or Degree?
College Name Location
Last Year Completed
1
2
3
4
more
Major Courses
Diploma or Degree?
Business or Trade School Name & Location
Months Attended
Major Courses
Diploma or Degree?
If you served in the United States Armed Forces, state the dates of service, and briefly describe the skills you acquired.
PERSONAL INFORMATION
Are you legally authorized to work in the U.S.?
Yes
No
(NOTE: You will be required to furnish documents to verify your eligibility for employment in accordance with the Immigration Reform and Control Act and your employment is contingent upon furnishing such documents.)
Name, address and telephone number of someone other than a household member we can contact in case of an emergency
Are you at least 18 years of age?
Yes
No
If no, state your age
Have you ever been convicted of a crime (felony)?
Yes
No
(A conviction does not automatically bar you from employment.)
If yes, give details of each instance
If you are an experience operator of any office machines or equipment, please list
Typing Speed (wpm)
Shorthand (wpm)
Do you have any other skills you wish to mention?
Are you presently employed?
Yes
No
If so, may we contact your present employer?
Yes
No
If hired, when would you be available?
Salary Requirements?
REFERENCES
Name of Reference
Occupation
Address
City, State, Zip
Phone
Additional References:
I certify that the answers given by me to the foregoing questions and statements are complete, and true and correct without consequential omissions of any kind. I agree that the company shall not be held liable in any respect if my employment is terminated because of false statements, answers or omissions made by me in this application. I understand that any misleading or incorrect statements may render this application void, and if employed, may lead to employment termination. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, and drug testing may be included as part of the regular pre-employment physical. I also acknowledge that the company may conduct a background check on me and investigate publicly available social network sites in which I may participate, and I consent to the company doing so. I also authorized the companies, school or persons named above to give any information requested regarding my employment, character and qualification. I hereby release said companies, schools, or persons from all liability for any damage for issuing this information. In consideration of my employment, I agree to conform to the rules and regulations of this organization. My employment and compensation can be terminated with or without cause and with or without notice, at any time, at the option of either my employer or myself. (Disclaimer - This is not legal advice, employer should review prior to use).
Signature (type full name)
Date
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