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Providing Specialty Tools for the Professional Technician

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Employment Application

Personal Information

Name *

First

Last

Email *

Email

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are You A U.S. Citizen? *

Yes
No

Will you submit to a Pre-Employment Drug Screen Test? *

Yes
No

Have you ever been convicted of a Felony? *

Yes
No

If Yes, Please provide dates(s) and details

Position

Position You Are Applying For *

Examples: General Assembly, Machine Operator, Material Handler, Shipping Clerk, Receiving Clerk, Buyer/Planner, etc.

Desired Rate of Pay *

Shift Availability *

First Shift 6:30am - 3:00pm
Second Shift 2:30pm - 1:00am

Available For Overtime *

Yes
No

Date Available To Start? *

Educational Background

Start with your most recent school attended

School (Include City & State) (1) *

Date Completed *//

As shown on Document Received

Document Received

Diploma
GED
Certificate
Degree
Other

If Other, Please Explain,

School (Include City & State) (2)

Date Completed//

As shown on Document Received

Document Received

Diploma
GED
Certificate
Degree
Other

If Other, Please Explain, (copy)

School (Include City & State) (3)

Date Completed//

As shown on Document Received

Document Received

Diploma
GED
Certificate
Degree
Other

If Other, Please Explain, (copy)

References

Name

Title

Company

Phone

Name

Title

Company

Phone

Name

Title

Company

Phone

Employment History

Start with your most recent employer

Employer (1)

Job Title

Date From//

Date To//

Work Phone

Starting Pay Rate

Ending Pay Rate

Address

City

State

Zip

Employer (2)

Job Title

Date From//

Date To//

Work Phone

Starting Pay Rate

Ending Pay Rate

Address

City

State

Zip

Employer (3)

Job Title

Date From//

Date To//

Work Phone

Starting Pay Rate

Ending Pay Rate

Address

City

State

Zip

Signature Disclaimer .................................................................................................................................................................................................................................................... By Signing below I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature *

Date Submitted *

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