Warehouse Worker Postal

***** - ********* ******-****

Oct *, ****

Personal Information

Complete the fields and click the arrow at the bottom to continue. Personal Information

Legal First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Santaisia Legal Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO SPECIAL CHARACTERS Galvan

Legal Middle Name .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Email Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *********@*****.*** Address 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4157 Moore st Address 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4157 Moore st City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inkster Mi Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . United States State/Province** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Michigan Zip/Postal Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48141 Primary Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313-***-**** General Information

Are you at least 18 years of age?

If no, hire is subject to verification that you are of minimum age to engage in work.

Yes

Please list any languages spoken in addition to English. If hired, can you provide proof of your legal right to work in the United States? Yes

If no, please describe your work authorization status.** Do you have relatives employed by Keystone Automotive Industries, Inc.? No If yes, give their names** .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shift Preference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1st Days Available Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, All Hours Available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . List, including AM or PM 7:00am 4:30pm

Training, Certifications, Skills (Optional)

Describe any other specialized professional training undertaken: .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fast past worker smart Specify professional designations, certifications, licenses or registrations held:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . San Id For Information Technology or Accounting positions, please indicate specialty:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Computer skills Other skills which could lend assistance in determining your qualifications/eligibility for employment:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Multitasking Employment History

To add additional employers, click the "Add Employer" button below. The "Remove Last Employer" will delete all entries for the last employer that you have entered. Start with your current or most recent position. If No previous employment please enter N/A. Employer 1

Name of Employer .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ajm packing Last Position Held . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Packer/ sorter Start Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08/15/2022 End Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If Current Employer please leave blank

Employer 2

Name of Employer .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dahon solution Last Position Held . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Carpet maker Start Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06/20/2021 End Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If Current Employer please leave blank

eSignature

I understand that if I am hired, I retain the right to terminate my employment and the Company retains a similar right to terminate my employment at any time for any reason. I acknowledge that if I am hired, I will be employed at will. I acknowledge that nothing contained in policies, practices, handbooks and other Company material create any guarantee of employment. Any promises to the contrary will be relied on by me only if they are in writing and signed by an authorized Company official. I understand that the Company has the right to modify, amend, or terminate policies, practices, benefit plans and other Company programs within the limits and requirements imposed by law. I understand that the accuracy and completeness of my statements will be relied on by the Company. I authorize investigation of all statements contained in this application, and I agree to execute any consent forms and/or provide any authorization necessary for the Company to obtain any transcripts, records or documents pertaining to my background and business experience. I also agree to release the Company from any liability arising therefrom and understand any misstatements, omissions or false statements made by me may results in refusal of employment or termination of employment if discovered after I am hired. E-Signature

ELECTRONIC SIGNATURE: Please type your full legal name

(Santaisia Galvan):

Santaisia Galvan

Accepted

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