Fork Lift Sheet Metal

LEE PRECISION MACHINE SHOP INC.

APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONNAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)

PERSONAL INFORMATION

DATE

NAME SS#

LAST FIRST MIDDLE

PRESENT ADDRESS

STREET CITY STATE ZIP CODE

PHONE NUMBER ARE YOU 18 YEARS OR OLDER? YES NO

EMPLOYMENT DESIRED

POSITION DATE YOU CAN START SALARY DESIRED

ARE YOU PRESENTLY EMPLOYED? YES NO MAY WE CONTACT PRESENT EMPLOYER? YES NO

EVER APPLIED WITH THIS COMPANY BEFORE? YES NO If so, When?

ARE YOU A US CITIZEN? YES OR NO

ARE YOU ELIGIBLE FOR EMPLOYMENT IN THE UNITED STATES? YES OR NO

ARE YOU 18 YEARS OF AGE OR OLDER? YES OR NO

HOW DID YOU LEARN OF OUR ORGANIZATION?

EDUCATION

NAME AND LOCATION

OF SCHOOL

*NO. OF YEARS

ATTENDED

*DID YOU GRADUATE?

SUBJECTS STUDIED

GRAMMAR SCHOOL

HIGH SCHOOL

COLLEGE

TRADE OR CORRESPONDENCE SCHOOL

FORMER EMPLOYERS (LIST PAST EMPLOYERS ENDING WITH PRESENT EMPLOYER)

DATE

MONTH AND YEAR

NAME AND ADDRESS OF EMPLOYER

SALARY

POSITION

REASON FOR LEAVING

FROM

TO

FROM

TO

FROM

TO

FROM

TO

REFERENCES: (GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU WHOM YOU HAVE KNOWN AT LEAST THREE YEARS)

NAME

ADDRESS

PHONE NUMBER

YEARS ACQUAINTED

1.

2.

3.

Have you ever been convicted of a felony or misdemeanor within the last 7 years? Yes or No If Yes, explain:

GENERAL

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK

DO YOU HAVE ANY SPECIAL LICENSES OR CERTIFICATIONS?

VETEREN: YES OR NO __

U.S. MILITARY OR SERVICE RANK PRESENT MEMBERSHIP IN NATIONAL GUARD OR RESERVES: YES NO

MANUFACTURING SKILLS: CIRCLE ALL THAT APPLY CNC PROGRAMMING CNC MILLING CNC LATHE MANUAL MILL

MANUAL LATHE FORK LIFT DRIVER SOLDERING EDM BLUE PRINT READING HEAT TREAT

SURFACE GRINDING WELDING SPOT WELDING SHEET METAL FABRICATION QUALITY CONTROL PAINTING

PHYSICAL RECORD:

DO YOU HAVE ANY PHYSICAL LIMITATIONS THAT PRECLUDE YOU FROM PERFORMING ANY WORK FOR WHICH YOU ARE APPLYING? YES NO

IF YES, WHAT CAN WE DO TO ACCOMMODATE YOUR LIMITATION?

IN CASE OF AN EMERGENCY NOTIFY:

NAME PHONE

“I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.”

“I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PRE VIOUS EMPLOYMENT AND ANY PERTINTENT INFROMATION THEY MAY HAVE PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FORM FURNISHING SAME TO YOU.”

“I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT PRIOR NOTICE.”

DATE SIGNATURE

DO NOT WRITE BELOW THIS LINE

INTERVIWED BY: HIRED: YES OR NO

SALARY WAGE: POSITION:

DATE REPORTING TO WORK: APPROVED BY:

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