Application for Employment

An Equal Opportunity Employer - M/F/V/H

Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related medical condition or handicap.

Each question should be fully and accurately answered. No action can be taken on this application until all questions have been answered. All information you give on this application will be held in strict confidence.

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* 1. Personal Data

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Which position are you applying for?

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* 3. Are you legally eligible for employment in the USA?

Yes

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* 4. State age if under 18 or over 70.

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* 5. What method of transportation will you use to get to work?

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* 6. Rate of pay expected per hour:

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* 7. If your application is favorable, on what date will you be available to start work?

Date / Time

Date

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* 8. Are there any other experiences, skills or qualifications which you feel would especially fit you for work with our company?

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* 9. On a scale of 1-100 how mechanically inclined are you?

0 - not at all

100 - very much so

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. How many years of manufacturing experience do you have?

1-2

3-5

over 5

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* 11. Highest level of education completed:

High School/GED

Apprentice/Trade/Vocational School

Associate Degree

Bachelor Degree

Other (please specify)

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* 12. Do you have any physical limitations that would limit your job performance for the position for which you are applying?

Yes

If yes, please specify.

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* 13. Do you have a valid driver's license?

Yes

State Issued and Driver's License Number:

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* 14. Were you ever employed here before?

Yes

If yes, when?

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* 15. Have you ever applied here before?

Yes

If yes, when?

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* 16. Have you ever been convicted of any law violation? (except minor traffic violations)

Yes

If yes, give particulars

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* 17. If you have worked under any other name, please give name:

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* 18. Are you presently employed?

Yes

If yes, may we contact your present employer?

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* 19. How were you referred to us?

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* 20. Complete information below regarding past employment

Dates of Employment

Employer Name

Employer Phone Number

Employer Address

Job Title

Name of Supervisor

Describe major duties

Wages

Reason for leaving

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* 21. Complete information below regarding past employment

Dates of Employment

Employer Name

Employer Phone Number

Employer Address

Job Title

Name of Supervisor

Describe major duties

Wages

Reason for leaving

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* 22. Complete information below regarding past employment

Dates of Employment

Employer Name

Employer Phone Number

Employer Address

Job Title

Name of Supervisor

Describe major duties

Wages

Reason for leaving

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* 23. What number is next in the series: 150,053, 150,054, 150,055, 150,056

150,057

15,057

150,060

1,557

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* 24. The decimal equivalent to 7/8 is:

.78

.125

.785

.875

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* 25. If 51,500 parts were produced yesterday and 50,100 parts today, how many total parts have been produced?

400

100,600

101,600

1,400

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* 26. Check the box next to any lines with exact duplicates:

Patterson, A. J. Paterson, A. J.

Smithsen, A. O. Smithsen, A. O

Bleed, O. M. Bleed, O. M.

Petersen, O. W. Peterson, O. W

Sussex, V.T Sussex, VT

Newport, KY. Newport, K.Y.

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* 27. Choose the smallest number:

1.2

.08

.999

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* 28. One job has a shipping date of 6/18 and another job has a shipping date of 7/1. Which job is due out first?

6/18 job

7/1 job