Position Applying For -- Position Applying For --Shipping ClerkProduction AssemblerMachine Shop Technician

Name (last, first, middle)

Email Address

Street Address and/or Mailing Address (include City, State and Zip)

Home Telephone Number

Business Telephone Number

Cellular Telephone Number

Date you can start work

Salary Desired

Check all that you are willing to work Check all that you are willing to work Full Time Part Time Days Evenings Swing Graveyard Weekends Regular Status Temporary Status

Do you have a High School Diploma or GED? Do you have a High School Diploma or GED? Yes No

Are you authorized to work in the U.S. on an unrestricted basis? Are you authorized to work in the U.S. on an unrestricted basis? Yes No

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an applicant for employment.) Yes No

If yes, please explain felony:

Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job? Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job? Yes No

Can you perform these essential functions of the job with or without reasonable accommodation? Can you perform these essential functions of the job with or without reasonable accommodation? Yes No

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.

First Reference (include full name, address, phone number and relationship)

Second Reference (include full name, address, phone number and relationship)

Third Reference (include full name, address, phone number and relationship)

Job Title

Company Name and Address

Supervisor Name and Phone Number

Duties

Reason for Leaving

Starting Date and Salary

Ending Date and Salary

May we contact your present employer May we contact your present employer Yes No N/A

Job Title

Company Name and Address

Supervisor Name and Phone Number

Duties

Reason for Leaving

Starting Date and Salary

Ending Date and Salary

Job Title

Company Name and Address

Supervisor Name and Phone Number

Duties

Reason for Leaving

Starting Date and Salary

Ending Date and Salary

Job Title

Company Name and Address

Supervisor Name and Phone Number

Duties

Reason for Leaving

Starting Date and Salary

Ending Date and Salary

Are you willing to work overtime during the week and on Saturdays? Are you willing to work overtime during the week and on Saturdays? Yes No

Can you work Monday through Friday from 6:00AM to 2:30PM? Can you work Monday through Friday from 6:00AM to 2:30PM? Yes No

Do you have reliable transportation? Do you have reliable transportation? Yes No

Can you speak and read English? Can you speak and read English? Yes No

Can you read a tape measure? Can you read a tape measure? Yes No

What is your minimum salary/wage expectation?

How many miles would your one-way commute to Bessemer be?

How many employers have you had in the last 2 years?

If hired, when are you available to start?

A piece of wood is three-and-a-half feet long. How many total inches long is it?

X + 2 = 10. What is the value of “X”?

What number is 50% less than 200?

What is the average of the following four numbers? 22, 47, 56, 25

According to the ruler shown here, how long is the gray line just above the ruler?

You are directed to paint a floor in a room that is five feet wide and ten feet long. How many square feet of the flooring will you be painting?

What will happen to Gear C in the figure above if Gear F is rotated clockwise?

Applicant Signature (Enter Full Name)