Personal Information First Name: Last Name: Email Address: Present Address: City: State: Zip Code: Permanent Address: City: State: Zip Code: Home Phone Number: Cell Phone Number: Referred By: Employment Desired Position: Date You Can Start: Wage Desired: Are You Employed?: YesNo If So, May We Inquire Of Your Present Employer?: YesNo Ever Applied To This Company Before?: YesNo When?: Are You Willing To Travel?: YesNo Education History High School: Years Attended: Did You Graduate?: YesNo Subjects Studied: College: Years Attended: Did You Graduate?: YesNo Subjects Studied: Trade School: Years Attended: Did You Graduate?: YesNo Subjects Studied: Work Experience Special Areas of Study/Work (i.e. Welding, Types of Dies (Trans. or Prog.), etc.): Former Employers (List Below Last Four Employers, Start With The Last One First) 1. From Date (Month/Year): To Date (Month/Year): Name & Address of Employer: Wage: Position: Reason For Leaving: 2. From Date (Month/Year): To Date (Month/Year): Name & Address of Employer: Wage: Position: Reason For Leaving: 3. From Date (Month/Year): To Date (Month/Year): Name & Address of Employer: Wage: Position: Reason For Leaving: 4. From Date (Month/Year): To Date (Month/Year): Name & Address of Employer: Wage: Position: Reason For Leaving: US Military Or Naval Service: Rank: References Give Below The Names of Three People Not Related To You, Whom You Have Known At Least One Year. 1. Name: Address: Business: Years Known: 2. Name: Address: Business: Years Known: 3. Name: Address: Business: Years Known: Attach Resume Attach Resume: Authorization I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. Yes, I agree By selecting "Yes, I agree" you are effectively applying an electronic signature to your agreement of the authorization above.