Name Last        First        Middle

Address        City        State         Zip     

Home Phone        Day/Message Phone        

EMPLOYMENT INFORMATION

Specific Position Applied for

Hours of Position Full Time Part Time Temporary   Date you can start work   Salary Desired $ per Hour Month Year

Why are you interested in this particular job?
 

What skills, training, and past experience qualify you for this position?
 

Professional Memberships and Affiliations

Professional and Trade Licenses

TRADE BACKGROUND [Complete this section only if applying for a Union position]

Member of Local #      Years experience in this trade     Years in Union

Type of work:    Shop   Field   Detailing   Service   Other

List certifications you have:   

EMPLOYMENT HISTORY

This section must be completed entirely.  Do not substitute a resume.  List all work experience, paid or unpaid, beginning with your current or most recent job.  Include military experience as well as volunteer jobs that you wish to have considered as part of your qualifications for the position you are seeking.

Describe each job separately, emphasizing your specific tasks and any supervisory, technical or other responsibilities.  Explain all breaks in continuous employment.

PRESENT OR LAST POSITION

Employer From      (month/year)

Address        To      (month/year)

Your Title Supervisors Name/Phone

Hours of Work Full Time Part Time              Hrs/Wk. (if varied, indicate avg.)  Paid      Unpaid     

Salary  per Hour Month Year

Last Year Salary per Hour Month Year   May we contact this employer?  Yes No

Duties/responsibilities (be specific)

Reason for leaving or considering a change

Employer From (month/year)

Address        To (month/year)

Your Title Supervisors Name/Phone

Hours of Work Full Time Part Time              Hrs/Wk. (if varied, indicate avg.)  Paid Unpaid

Salary  per Hour Month Year

Last Year Salary per Hour Month Year   May we contact this employer?  Yes No

Duties/responsibilities (be specific)

Reason for leaving or considering a change

Employer From (month/year)

Address        To (month/year)

Your Title Supervisors Name/Phone

Hours of Work Full Time Part Time           Hrs/Wk. (if varied, indicate avg.)  Paid Unpaid

Salary  per Hour Month Year

Last Year Salary  per Hour Month Year   May we contact this employer?  Yes No

Duties/responsibilities (be specific)

Reason for leaving or considering a change

EDUCATION

Highest grade completed in school 1 2 3 4 5 6 7 8 9 10 11 12      College 0 1 2 3 4     Graduate 0 1 2 3 4

High School
Name of School   Location
Diploma

College or University
Name of School   Location
Diploma or Degree   Major

Graduate School
Name of School   Location
Diploma or Degree   Major

Vocational or Training
Name of School   Location
Diploma or Degree   Major

REFERENCES [List business/work references]

Name   Company/Title     

Phone      Years Known     

Name   Company/Title     

Phone      Years Known     

Name   Company/Title     

Phone      Years Known     

HUMAN RESOURCES ONLY [CONFIDENTIAL]

PLEASE READ THE FOLLOWING CAREFULLY BEFORE INITIALING THIS APPLICATION

McKinstry Co. and essention are equal opportunity employers and do not discriminate on the basis of gender, age, race and color, religion, marital status, national origin, disability or veteran status.

Interviews are given on a competitive basis, using job-related factors, after a written application has been received and reviewed.  Because of the large number of applications received, not everyone who applies for a vacant position will be interviewed.

I understand that, if selected, I will be required to provide proof of my identity and my legal right to work in the United States prior to actual employment with McKinstry Co. and essention. (initial here)

I understand that any offer of employment is contingent upon passing a pre employment drug screening and alcohol test.   (initial here).

I certify that I have answered truthfully and have not knowingly withheld any information relative to my application.  I understand that a  misrepresentation or material omission on this application will result in my being eliminated from further consideration.  I further understand that, if accepted for employment, any misrepresentation or material omission which becomes known to McKinstry Co. or essention may result in immediate termination of my employment. (initial here)

I authorize all previous employers and supervisors, including all persons with and for whom I have worked, to give McKinstry Co. representatives any and all information regarding me and my previous employment.  I release McKinstry Co. and essention, and all previous employers and supervisors from liability for any damages that may result from furnishing information to McKinstry Co. or essention.  (initial here)

All candidates will be required to physically sign and initial application before completing the interview process.

Are you over 18 years of age?  Yes No  If NO, a work permit will be required

Legally eligible for permanent employment in the United States?   Yes No (if hired verification required by law)

Drivers License No.    State (if required by position)    Social Security #

Have you ever been employed by this company before? When? In what job?

Have you ever been convicted of a felony within the last 7 years?  No Yes
If yes, please indicate type of offense, court in which you were convicted, and date of conviction.

APPLICANT EQUAL EMPLOYMENT OPPORTUNITY INFORMATION

It is the policy of this organization to provide equal employment opportunity to all qualified applicants for employment without regard to race, color, religion, national origin, sex, age, veteran status or disability. Various agencies of the government require us to invite applicants to identify themselves as indicated below. Completion of this form is voluntary and in no way affects the decision regarding your application for employment. This information will be kept confidential.

What is your race/ethnic origin? Select One White/Caucasian Two or More Races (Not Hispanic or Latino) Asian (Not Hispanic or Latino) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) Black or African American (Not Hispanic or Latino) Hispanic or Latino American Indian or Alaskan Native (Not Hispanic or Latino) Do Not Wish To Disclose

What is your sex? Select One Male Female