Employment Application

Employment Application
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Are you 18yrs or older?*
If no, what is your date of birth?
If hired, can you produce proof of age?*
Do you have a valid motor vehicle operator’s license?
Has if ever been revoked?
If yes, please explain.
Do you have another job or “sideline” business? If so, state type of business or job and hours you work at your own business or other job*
Is there anything that might affect your attendance?*
Are you able to lift 50 pounds?
If you are applying for a Full-Time position, can you be at Custom Machine Works (Monday thru Friday) 40 hours a week?

Education *

	Name and Location	Highest Grade Completed and Year
High School
College or University
Trade School
Other skill or special training

Service *

	Branch	Rank	Date Entered	Date Discharged	Duties while in service
Military Service

Are you a member of Reserve or National Guard?*
Stand by or Ready?
Employment Desired
Position *
Wage Desired*
Date you can start*

MonthDayYear
Date
How would you get to work?*
Shifts you are willing to work?*
Can you work full-time or part-time?*
Are you willing to work overtime and Saturdays if required to?*
Name of Relative and/or friends employed here*
Have you ever applied or been employed by Custom Machine Works?*
Have you ever been convicted of a felony?*
If Yes, Explain in Detail
May we contact your present employer?*
If currently employed, why do you desire to change?
Have you EVER been discharged or forced to resign from ANY job? If so, explain*
Have you drawn unemployment insurance in the past year?*
If Yes, date and amount of last benefit drawn
Former Employment

List below the last three employers starting with the most recent
Employer #1
Employer #2
Employer #3
References (Give name, address, and occupation of three persons (no relatives) SKIP THIS SECTION IF ON RESUME.
It is understood and agreed that any misrepresentation by me in this application will be cause for cancellation of this application and/or separation from my job if I have been employed. I UNDERSTAND THAT JUST AS I AM FREE TO RESIGN AT ANY TIME, THE EMPLOYER RESERVES THE RIGHT TO TERMINATE MY EMPLOYMENT AT ANY TIME WITH OR WITHOUT CAUSE AND WITHOUT PRIOR NOTICE. I understand that no representative of the Employer has the authority to make any assurances to the contrary. I give the Employer the right to investigate all references and to secure additional information about me if job related. I release from liability the Employer and any representatives for seeking such information and all persons, corporations, and organizations for furnishing such information. This application is current for 60 days. After that, if I have not heard from the Employer and still want to be considered for employment, it will be necessary for me to fill out a new application.
Signature of Applicant*

Clear
Should be Empty:

Employment Application

Employment Desired

Former Employment