Form

1. APPLICATION FOR EMPLOYMENT

There are 7 sections to this application form.
Holbein, Inc.
Address: P.O. Box 156, Saver, PA 16055 | Phone: 724-353-2635

Holbein, Inc. is an equal opportunity employer
Date of Application Submission *

- Month - Day Year
First Name *
Last Name *
Phone Number *

- Area Code Phone Number
Email
Address *
City *
State *
Zip *
Township *
Local Wage Tax District
Position Applying for *
Are you willing to do other jobs? *

Yes No
Special Qualifications for Position *
What Type/Make Equipment Do You Operate? *
Driver's License # *
State *
Class *
Any Speeding Tickets in the last 5 years? *

Yes No
If "Yes", list offense and date
Have you been convicted of a felony? *

Yes No
If "Yes", list felony and date

2. MILITARY SERVICE RECORD
Are you currently enlisted or have you ever served in the military? If you have not served in the military, please check "No" and continue to section three. *

Yes No
Branch of Service
Discharge Date

- Month - Day Year
Rank
Presently in National Guard and/or Reserves?

Yes No
Obligation Ends

- Month - Day Year

6. APPLICANT QUESTIONNAIRE
1. How many days a year do you call off?
2. Are you willing to work weekends? If not, why?
3. Are you willing to start before 7AM and work later than 5PM when needed?
4. Do you have problems following orders from a supervisor?
5. How concerned are you with safety? Is working safely your #1 goal?
6. What is your opinion on equipment and maintenance?
7. Are you concerned at completing the best possible quality work?
8. What are your goals for your future within the company?
9. How often do you change jobs and why?
10. Are you looking for long term employment?
11. Are you willing to perform other jobs?
12. How would you describe your personality?
13. How would you describe your attitude towards work?
14. What are the most important qualities to being a team member and why?
15. Number these in your order of importance: Teamwork, Quality, Productivity, Safety
16. Do you follow directions?

APPLICANT QUESTIONNAIRE CONTINUED
How did you hear about Holbein, Inc.? (I.E. Employee Referral, Facebook, Newspaper)
Please provide any additional comments here:

7. SUBMIT YOUR APPLICATION
________________________________________________________
Signature

By typing your name below, you signify that the application you are submitting is complete and accurate in its entirety.
Please type your full name to signify your signature *

First Name Last Name
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2. MILITARY SERVICE RECORD