Application for Employment
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location Applying To:
Louisa, VA
Chester, VA
Houston, TX
Are you 18 years of age or older?
*
Yes
No
Are you either a U.S. Citizen or someone otherwise authorized to work in the U.S.?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
If you answered yes to the question above, please describe:
Do you know anyone who currently or formerly worked at Patriot Industries?
*
Yes
No
If you answered yes to the question above, please describe:
Have you ever worked or attended school under another name? If so, under what name?
Position Desired
Position Desired:
Start Date Available
Wage Rate Desired:
Type of Wage
Hourly
Monthly
Annually
Do You Prefer:
Full Time
Part Time
If Part Time, Hours Per Week Desired:
Hours You Are Available To Work:
Days of the Week You Are Available To Work:
Are You Able To Work:
Weekends
Holidays
Nights
Overtime
Have You Previously Worked For Patriot Industries?
Yes
No
Dates of Employment with Patriot Industries:
Reason(s) For Leaving:
Education
High School
Yes
No
H.S. Years & Course Of Study:
Technical School
Yes
No
T.S. Years & Course Of Study:
College/University
Yes
No
C/U Years & Course Of Study:
Post Graduate Education:
Yes
No
PGE Years & Course Of Study:
Other Education, Training Or Special Skills
Skills
Are You Fork Lift Certified?
Yes
No
If Yes, Last Certified Date:
Do You Have A CDL?
Yes
No
CDL A
CDL B
Typing Speed (WPM):
Which Of These Software Programs Are You Comfortable Using?
Word
Excel
Powerpoint
Netsuite
Google Sheets
Google Docs
Google Slides
Other
List Any Additional Skills You Think Are Important To The Job For Which You Are Applying:
Work Experience
Please List All Previous Employment, Beginning With The Most Recent.
Employer Name:
Address:
Dates Employed:
Position Held:
Reason for Leaving:
Supervisor's Name & Title:
Supervisor's Name & Title:
May We Contact?
Yes
No
Description Of Duties:
Starting & Final Compensation:
Employer Name:
Address:
Dates Employed:
Position Held:
Reason for Leaving:
Supervisor's Name & Title:
Supervisor's Name & Title:
May We Contact?
Yes
No
Description Of Duties:
Starting & Final Compensation:
Employer Name:
Address:
Dates Employed:
Position Held:
Reason for Leaving:
Supervisor's Name & Title:
Supervisor's Name & Title:
May We Contact?
Yes
No
Description Of Duties:
Starting & Final Compensation:
Upload Resume & References
If Available, Please Upload Your Resume & References:
Current Resume:
Browse Files
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Authorization & Acknowledgements
I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in this application is grounds for rejection of my application, and that providing false or misleading information in this application is grounds for discharge. I authorize the company to verify my references, record of employment, education record, and any other information I have provided. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.
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