APPLICATION FOR EMPLOYMENT
PLEASE FILL OUT APPLICATION COMPLETELY. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. FILL OUT ALL FIELDS AND DO NOT WRITE "SEE RESUME."
Applicant Information
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Which location are you applying to?
*
Please Select
Prineville Office
Bend Office
Redmond Office
Madras Office
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Name
*
First & Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
Phone Number
*
Military Service
Military Service: Date Entered (If applicable)
Military Service: Date Separated (If applicable)
Military Service: Honorable Discharge? (If applicable)
Yes
No
Military Service: Rank (If applicable)
Military Service: Branch (If applicable)
Military Service: Occupation (If applicable)
High School Education
What is the highest grade/year completed in school?
*
Please Select
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Name of high school
*
Location of high school
*
Did you graduate high school?
*
Yes
No
GED
Year diploma was/would have been granted
*
School Attended after High School #1
Name/Location & Dates From/To
Full-time or Part-time
Please Select
Full-time
Part-time
Field of study (Major & Minor)
Hours completed (Semester)
Hours completed (Quarter)
Did you graduate?
Please Select
Yes
No
Certificate or degree earned
School Attended after High School #2
Name/Location & Dates From/To
Full-time or Part-time
Please Select
Full-time
Part-time
Field of study (Major & Minor)
Hours completed (Semester)
Hours completed (Quarter)
Did you graduate?
Please Select
Yes
No
Certificate or degree earned
Professional References
Professional Work Reference #1 - Name
Professional Work Reference #1 - Phone number
Professional Work Reference #1 - Email
Professional Work Reference #2 - Name
Professional Work Reference #2 - Phone number
Professional Work Reference #2 - Email
Professional Work Reference #3 - Name
Professional Work Reference #3 - Phone number
Professional Work Reference #3 - Email
Please provide the last four digits of your Social Security Number:
Will you be able to provide proof of Citizenship or an alien registration number and visa permitting work in thiscountry if hired?
Yes
No
By this application and my signature, I authorize you to check the validity of my social security number and other pertinent identification. Please INITIAL.
Employment Desired
1st Position desired
*
2nd Position desired
3rd Position desired
Are you seeking regular (full-time) employment?
*
Yes
No
Are you seeking Part-time employment?
*
Yes
No
If seeking temporary employment, when would you expect to terminate?
Date you can start
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Salary or wage desired
*
Are you willing to accept odd (nights, graveyard or weekend) or rotating shifts?
*
Yes
No
Have you ever applied to this company before?
*
Yes
No
If yes, when and where?
What is the most amount of weight that you're able to lift or carry for prolonged periods?
*
Please Select
10 lbs
20 lbs
30 lbs
40 lbs
50 lbs
Over 50 lbs
What you have done in the recent past to demonstrate that you can lift or carry the amount of weight entered above?
*
How many days did you miss from work this past year?
*
Special Skills
Special Skills: Please mark box if you have 3 or more months experience for wages
Forklift
Truck driver
Lumber chain pulling
Cutoff saw
Resaw operator
Planer setup
Moulder setup
Tieing from moulder
Finger joint operator
Finger joint offbearer
Welding
Maintenance millwright
Carpentry
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Employment History
Please list, starting with your most recent employer.
Most recent job
Name, Address, and Phone of Company
*
Employed From AND To (Month & Year)
*
Primary Duties Performed
*
Immediate Supervisor & Reason for leaving
*
Job #2
Name, Address, and Phone of Company (Enter N/A if not applicable)
*
Employed From AND To (Month & Year) (Enter N/A if not applicable)
*
Primary Duties Performed (Enter N/A if not applicable)
*
Immediate Supervisor & Reason for leaving (Enter N/A if not applicable)
*
Job #3
Name, Address, and Phone of Company
Employed From AND To (Month & Year)
Primary Duties Performed
Immediate Supervisor & Reason for leaving
Explanation of Special Skills
Please include any special skills (Enter N/A if not applicable)
*
Emergency Contact & Authorization
Emergency Contact (Name, Relationship, Phone Number)
*
I HEREBY AUTHORIZE YOU TO CONSULT AND OBTAIN INFORMATION FROM ANY EMPLOYER I AM WORKINGOR HAVE WORKED FOR:
*
Yes
No
Authorization
I authorize the investigation of all matters which PSI deems relevant to my qualifications for employment, including all statements made in this application and in any attachments or supporting documents. I authorize PSI to request, receive and share with any agent or client employer such information and I release from all liability any persons, such as but not limited to, supervisors or employers supplying it. I also release PSI and any of its agents or client employers from all liability which might result from making the investigations. If employed, I understand that misrepresentation or omission of facts called for is cause for dismissal. If offered employment, I am also willing to take a physical examination and authorize the doctor or doctors involved to disclose to the prospective employer here and any of its agents or client employers the results of that examination. I agree to comply with the employer's substance abuse program, including drug testing as may be required. If employed, I agree to conform to the rules of this company, and hereby acknowledge that my employment with the company can be terminated at any time, with or without cause, at the option of either myself or the company. I further understand and acknowledge that nothing contained in any employee handbook or policy statement nullifies or modifies the foregoing employment at will policy.
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
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