APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
P. O. Box 1240 Tilton, NH 03276

Phone: 603-286-7657 Fax: 603-286-7882

TSI is an equal opportunity employer and all information provided on this form will be kept in the strictest confidence. Certain information (POB, DOB, SSN, Convictions, etc) is required for US Security Clearance purposes only.
PERSONAL INFORMATION
NAME:
Name

First Name Middle Name Last Name
PHYSICAL ADDRESS:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mailing Address (if different):
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
CELL PHONE NO:
Phone Number
Please enter a valid phone number.
EMAIL ADDRESS:
example@example.com
PLACE OF BIRTH:
SOCIAL SECURITY NUMBER:
DATE OF BIRTH:
UNITED STATES CITIZEN?

Yes No
If No List Country of Citizenship
HAVE YOU EVER BEEN CONVICTED OF A FELONY?
No Yes
If Yes Please Explain:
UNION AFFLIATION:
ARE YOU CURRENTLY A UNION MEMBER?

No Yes
(IF YES) DC#
CURRENT UNION LEVEL

JOURNEYMAN APPRENTICE Other
EDUCATION
LIST HIGHEST LEVEL COMPLETED (GED, HS, College, etc):

LIST SPECIAL SKILLS / CERTIFICATIONS : (C3,C5,C7,QC, NACE, etc):

*Please Provide copies of all certifications listed.
MILITARY SERVICE
Yes No
Branch
Rank
Discharge
CURRENT MEMBER GUARD OR RESERVES

Yes No
If Yes State:
EMPLOYMENT DESIRED
Position:
State:
Date Available to Start:
Are you currently employed?

Yes No
Current Employer:
How Long Were You Employed?
Have you ever worked for TSI before?

Yes No
If Yes, When?
EMPLOYMENT HISTORY
FORMER EMPLOYERS:
PHYSICAL RECORD
Do you have any physical limitations that prevent you from performing any work for which you are being considered?

No Yes
If yes, please explain:
Emergency Contact
I certify that the facts contained in this application are true and complete to the best of my knowledge and I 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 you 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 damage that may result from furnishing same to you.
I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.
File Upload (Certs and licenses)

Cancel of
Signature

Clear
Date:
P. O. Box 1240 Tilton, NH 03276

Phone: 603-286-7657 Fax: 603-286-7882 www.GoToTSI.com
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APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

NAME:

PHYSICAL ADDRESS:

CELL PHONE NO:

EMAIL ADDRESS:

PLACE OF BIRTH:

SOCIAL SECURITY NUMBER:

DATE OF BIRTH:

HAVE YOU EVER BEEN CONVICTED OF A FELONY?

UNION AFFLIATION:

EDUCATION

MILITARY SERVICE

EMPLOYMENT DESIRED

EMPLOYMENT HISTORY

FORMER EMPLOYERS:

PHYSICAL RECORD