APPLICANT INFORMATION

*Last Name:

*First Name:

M.I.:

*Date:

*Street Address:

Apartment/Unit#:

*City:

*State:

*ZIP:

Phone:

Cell Phone:

How did you hear about us:

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: