DuBois Chemicals

charles milton's Employment Application

Date Submitted: 2/27/2019

Job Title: Forklift Driver

Job Location: Sharonville

Personal Information

First Name: charles

Last Name: milton

Email: ad3at4@r.postjobfree.com

General Information

Current Address

Address: 1169 Byrd Ave. #2

Address #2: n/a

City: Cincinnati

Zip/Postal Code: 4521t

Country: United States

State: OH

Contact Information

Cell Phone: 513-***-****

Home Phone: 513-***-****

General Information

Are you 18 years of age or older? Yes

If no, can you furnish a work permit? n/a

Work Authorization: I am authorized to work in this country for any employer. Will you now or in the future require sponsorship for employment VISA status? No Have you previously filled out an application at this company? No If yes, please give date(s) and position(s): n/a

Have you ever worked for this company before? No

If yes, please give date(s) and position: n/a

How did you hear about this opportunity? Indeed

If referred by a current employee, please give employee name: n/a Are you related to any person currently employed at this company? : No If yes, please explain: n/a

Are you applying for: Full Time

Desired Compensation: 14.00

Available Start Date: 02/26/2019

Employment History

Please provide the following requested information regarding your employment history: Include military service assignments and volunteer activities. You may exclude organization names that include race, color, religion, gender, national origin, ancestry, age, disability or other protected status.: Current or Most Recent Employer:

Are you currently employed? No

Company Name: n/a

City and State: n/a

Title: n/a

From (MM/YY): n/a

To (MM/YY): n/a

Reason for Leaving: n/a

Explanation: n/a

Rate of Pay: n/a

Direct Supervisor: n/a

Company Phone: n/a

OK to contact? n/a

Responsibilities and Duties: n/a

2nd Previous Employer:

Company Name: Lute Supply

City and State: Cincinnati Ohio

Title: Warehouse/forklift driver

From (MM/YY): 05/18

To (MM/YY): 09/18

Reason for Leaving: Resigned

Explanation: Had to have knee surgery

Rate of Pay: 14.00

Direct Supervisor: Charles Hanson

Company Phone: 513-***-****

OK to contact? Yes

Responsibilities and Duties: Pull order using RF gun,deliver said items to customer, Sometimes using forklift 3rd Previous Employer:

Company Name: Job center

City and State: Cincinnati Ohio

Title: Warehouse worker

From (MM/YY): 03/18

To (MM/YY): 05/18

Reason for Leaving: Resigned

Explanation: Took full time job

Rate of Pay: 13.50

Direct Supervisor: n/a

Company Phone: 513-***-****

OK to contact? Yes

Responsibilities and Duties: Put material on conveyor belt. Education/Training

High School:

Name of School: Moeller

City and State: Cincinnati Ohio

Grade Completed: 12

Graduate or GED? Yes

College or University:

Name of School: Illinois State University

City and State: Bloomington Illinois

Course or Major: Accounting

Years Completed: 2

Degree: n/a

Graduate? No

Graduate School:

Name of School: n/a

City and State: n/a

Course or Major: n/a

Years Completed: n/a

Degree: n/a

Graduate? No

Other:

Name of School: n/a

City and State: n/a

Course or Major: n/a

Years Completed: n/a

Degree: n/a

Graduate? n/a

Please list any languages that you are proficient or fluent in: n/a List professional, trade, business, or civic activities and offices held. (You may exclude memberships that would reveal race, color, religion, gender, age, ancestry, national origin, disability, or other protected status): Certified forklift operator from Cincinnati Bobcat,Lutesupply

References

Please list three professional references:

Reference Name: Kelvin Waver

Company: Might Imvestment llc

Relationship: None

Phone: 513-***-****

Email: n/a

Years Known: 20

Reference Name: Peter Hunter

Company: Lute Supply

Relationship: Friends

Phone: 513-***-****

Email: n/a

Years Known: 5

Reference Name: Yvette Holland

Company: Burlington

Relationship: Friends

Phone: 513-***-****

Email: n/a

Years Known: 4

Applicant's Statement

I certify that my answers to all questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statements made on this application or during the pre-employment process may be grounds for my immediate termination.: I have read and agree to this disclaimer: Yes

Applicant Signature: Charles Milton

Date: 2-26-2019

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