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Applicant's Name

Job Applying for

Your Email

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Message Phone

Address

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I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States.

YES NO

Are you 18 years old or older?

YES NO

Have you ever been employed by this company?

YES NO

If yes, when and in what position?

Date you can begin work

Shifts you can work (check all that apply)

PRODUCTION DAY (Monday-Friday, 6 am to 4 pm OFFICE DAY (Monday-Friday, 8 am to 5 pm PRODUCTION SWING (Monday-Friday, 4:30 to 2:30 am)

Will you work overtime when scheduled or requested?

YES NO

Can you work on weekends whenever shceduled or requested?

YES NO

Special Skills you possess:

High School

Location

Level Completed

GED Graduate did not Graduate

College/University

Location

Degree

Associates Bachelors none

Vocational School

Location

Degree/Certificate

graduated certificate none

Graduate School

Location

Degree

Masters PhD none

List the last four positions you have held beginning with your present or last employer. Explain any lapses between times when employed. MUST BE FILLED OUT, EVEN IF ATTACHING RESUME

Employer 1

Job title

Address

City

State

Zip

Supervisor

Supervisor phone

Supervisor email

Duties/responsibilities (be specific):

Reason for leaving:

Previous Employer 2

Job title

Address

City

State

Zip

Supervisor

Supervisor phone

Supervisor email

Duties/responsibilities (be specific):

Reason for leaving:

Previous Employer 3

Job title

Address

City

State

Zip

Supervisor

Supervisor phone

Supervisor email

Duties/responsibilities (be specific):

Reason for leaving:

Previous Employer 4

Job title

Address

City

State

Zip

Supervisor

Supervisor phone

Supervisor email

Duties/responsibilities (be specific):

Reason for leaving:

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JOB ANALYSIS

Work Hours: 8-10 hours per day
Overtime hours: 0-18 hours per week
Number of days worked: 5-6

Physical Requirements*

Stand: 6-12 hours per day
Walk: 3-5 hours per day
Bend/stoop: 2-4 hours per day
Squat: 2-4 hours per day
Crawl/kneel: 0-1 hours per day
Climb: 0-1 hours per day
Reach: 0-3 hours per day
Push: 0-6 hours per day
Pull: 0-6 hours per day
Lift/carry 50 to 150 lbs.
Carry a distance of up to 250 feet (may be required to carry cabinets up steps or across terrain)