APPLICANT INFORMATION

Last Name:

First Name:

M.I.:

Date:

Street Address:

Apartment/Unit#:

City:

State:

ZIP:

Phone:

Cell Phone:

E-Mail Address:

Date Available:

Position Applied for:

Referred by:

Do you know anyone who works for our company?

Can you work any shift?

YES

NO

If no, explain:

Can you work weekends?

YES

NO

If no, explain:

Are you a citizen of the United States?

YES

NO

If no, are you authorized to work in the U.S.?

YES

NO

Have you ever worked for this company?

YES

NO

If so, when?

Have you ever been convicted of a felony?

YES

NO

If yes, explain:

Are you a veteran?

YES

NO

Date and Type of Discharge:

Can you weld?

YES

NO

If yes, type of experience:

Have you ever Operated a Press?

YES

NO

If yes, type and length of time:

Do you have Quality experience?

YES

NO

If yes, what:

Have you ever done Maintenance work?

YES

NO

If yes, explain:

List any training or special skills.

EDUCATION

High School:

Address:

From: To:

Did you graduate? YES NO

Degree:

College:

Address

From: To:

Did you graduate? YES NO

Degree:

Other:

Address

From: To:

Did you graduate? YES NO

Degree:

PREVIOUS EMPLOYMENT (LIST MOST CURRENT FIRST)

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

$

Responsibilities

From To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Reference 1

Name:

Number:

Relation:

Reference 2

Name:

Number:

Relation:

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I understand that if offered a position with T.RAD, I may be required to submit to a pre-employment medical or physical examination and a drug screen. I understand that unsatisfactory results from, refusal to cooperate with, or any attempt to effect the results of these pre- employment test will result in withdrawal of any employment offer or termination of employment if already employed.

I understand that this application is considered current for three months. If I wish to be considered for employment after this period I must fill out and submit a new application.

Signature: Date: