Employment Opportunities - Signature Millshop

Your Information

Name*

First Last

Phone*

Email*

Address

Street Address City State ZIP Code

Date of Birth

Age

Number of Dependents

Marital Status

Married
Single

The 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?

Yes
No

Rank

Present membership in National Guard or Reserves

Are you presently employed?

Yes
No

May we contact your current employer?

Yes
No

Employers information:

Wage/hr. desired

Date you can start:

Physical Record

Do you have any physical limitations that preclude you from performing any work for which you are being considered?

*If yes, please describe.

Yes
No

Please describe any physical limitations you may have:

In case of emergency, notify:

Emergency Contact Name

First Last

Emergency Contact's Address

Street Address City State ZIP Code

Emergency Contact's Phone

Education

High School

High School Address

Street Address City State ZIP Code

High School Phone

Years attended

Did you graduate?

Yes
No

Date of graduation

Trade or Vocational School

Trade or Vocational School Address

Street Address City State ZIP Code

Trade or Vocational School Phone

Years attended

Did you graduate?

Yes
No

Date of graduation

Major course of study

Other (College, Business School, Correspondent Courses, etc.)

Work History

Company Name

Most recent.

Company Phone

Company Address

Street Address City State ZIP Code

Starting date - Ending date

Ending wage

Supervisor

Reason for leaving

Job responsibilities

Company (2) Name

Previous to most recent employment.

Company (2) Phone

Company (2) Address

Street Address City 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:

Please check any of the following stationary power tools you are skilled with:

Please check any of the following skills you have:

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 comments

We 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

Application for Shop Employment

Your Information

Physical Record

Education

Work History