Date *

Personal

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Name *

Address

Email *

Phone Number *

Date of Birth *

Have you ever applied here before? *

YesNo

If so, when?

Have you ever had any previous association with this company?*

YesNo

If so, when?

Reason for leaving

Are you employed?*

YesNo

If not, how long since last employment?

Were you referred to our company?*

YesNo

If so, by whom?

Education

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Highest grade completed: *

123456789101112

College

1234+

Last school attended: Name *

Last school attended: Address*

Did you graduate?*

YesNo

Degrees or honors received:

Other education

Military Status

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Have you ever served in the U.S. Armed Forces?*

YesNo

Branch

Date from:

Date to:

Are you currently a member of the Active Reserves or National Guard?*

YesNo

List any special skills or training that you received:

Work Experience

Beginning with your present or most recent employer, accounting for any gaps in employment. Please show the past three years of employment.

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Name of Company

Phone

Address

Street Address

Address Line 2

Date employment began:

Date employment ended:

Reason for leaving

Job title

Name of supervisor

Any accidents?

YesNo

Equipment operated

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Name of Company

Phone

Address

Street Address

Address Line 2

ZIP Code

Date employment began:

Date employment ended:

Reason for leaving

Job title

Name of supervisor

Any accidents?

YesNo

Equipment operated

Additional Information

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Are you physically able to perform heavy manual work?*

YesNo

Consent

Yes

Comments

It is the policy of Plastic Fusion Fabricators to maintain and promote equal employment opportunities without regard to race, color, gender, age, religion, disability, national origin or other non-merit factors. This policy includes but is not limited to employment, advancement, demotion, transfer, recruitment, layoff, termination, pay rates, etc. If you need assistance with completing this application or during any phase of the employment process, please notify the Human Resources Department at: [email protected], 256.852.0378, and every effort will be made to accommodate your needs in a reasonable amount of time.

By typing my name below I certify that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. I also agree that any falsified information and / or significant omissions may result in my disqualification from employment now or at any time. I understand that this organization participates in E-Verify.

Name*

Date*

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