Application for Shop Employment Your InformationName* First Last Phone*Email* Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of BirthAgeNumber of DependentsMarital StatusMarriedSingleThe age of discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.U.S. Military or Naval Reserves?YesNoRankPresent membership in National Guard or ReservesAre you presently employed?YesNoMay we contact your current employer?YesNoEmployers information:Wage/hr. desiredDate you can start: Physical RecordDo you have any physical limitations that preclude you from performing any work for which you are being considered?*If yes, please describe.YesNoPlease describe any physical limitations you may have:In case of emergency, notify:Emergency Contact Name First Last Emergency Contact's Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact's PhoneEducationHigh SchoolHigh School Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code High School PhoneYears attendedDid you graduate?YesNoDate of graduationTrade or Vocational SchoolTrade or Vocational School Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Trade or Vocational School PhoneYears attendedDid you graduate?YesNoDate of graduationMajor course of studyOther (College, Business School, Correspondent Courses, etc.)Work HistoryCompany NameMost recent.Company PhoneCompany Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Starting date - Ending dateEnding wageSupervisorReason for leavingJob responsibilitiesCompany (2) NamePrevious to most recent employment.Company (2) PhoneCompany (2) Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code The following questions are a survey of your skills and abilities as they may pertain to employment. Note, not all skills are required for employment. Please check any of the following electric or air hand tools you are skilled with: Router Chop Saw Air Nailer/Stapler Belt Sander Lip Planer Drill Jig Saw Heat Gun Screw Gun Biscuit Jointer Laminate Trimmer Laminate Seam Router Air T-Molder Hammer Paint Spray Gun Random Orbit Sander Please check any of the following stationary power tools you are skilled with: Table Saw Shaper Drill Press Edge Bander Beam Saw Jointer Metal Band Saw Band Saw Laminate Slitter CNC Machine Radial Arm Saw Disc and Belt Sander Line Boring Machine Sliding Table Saw Point-to-Point Machine Please check any of the following skills you have: Read architectural drawings Build cabinets from shop drawings Figure cut sheets/optimize material Drive Fork Lift Build tool and assembly jigs Build display units out of plexiglass Cover display units with fabric carpet Maintain and repair shop tools and equipment Finishing (stain, cleat coating, etc.) On-site installation of displays and cabinetry Building cabinets or display units out of wood up to stain or natural wood finish stage Building cabinets or displays out of particle board or plywood and finish with plastic laminate Building melamine casework with pvc and/or laminate edging Assembly of drawer slides, concealed hinges, and door/drawer pulls etc. Laminating (including cutting laminate, spraying contact cement, routing and filing) Shop math (lay-out, geometric shapes, miters, material footage, etc.) Electrical wiring switches and lights in display cases and exhibits Building units requiring use of steel or sheet metal Do you own a current fork-lift operator's license Building maintenance (electrical, heating, plumbing, etc.) Please list tools and skills not listed above that you feel would be valuable for employment:Do you have a drivers license? If yes, what state?Have you had any moving violations in the last three years?This job requires drug testing. Will this be a problem?Do you own your own hand tools?Other commentsWe do drug testing. Will that be a problem?* No Agreement*"I certify that the facts in the 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 listed above to give any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damages that may result. I understand and agree that, if hired, my employment is for no definite period and may, regardless of that date of payment of my wages and salary, be terminated at any time without any prior notice." I Agree