APPLICATION FOR EMPLOYMENT

at
AJ MANUFACTURING, INC.
(an Equal Opportunity Employer)
1217 Oak Street, Bloomer, WI 54724
715-568-2204

Job you are applying for:
How did you learn about us?
Advertisement Relative Inquiry
Employment Agency Friend Other
Who referred you to our company:
First Name: Middle Initial: Last Name:
Address: City: State: Zip:
Telephone Number: Alternative Telephone Number:
Best time of day to contact you at home is ...
If you are under 18 years of age, can you provide required proof of your eligibility to work?....... Yes No Not Aplicable
Are you currently employed?....... Yes No | If employed may we contact your current employer?....... Yes No
Have you ever filed an application with us before?........... Yes No -- If Yes, give date: (E.g. 2/28/2010)
Have you ever been employed with us before?................. Yes No -- If yes, give date: (E.g. 2/28/2010)
Do any of your friends or relatives, (other than a spouse,) work here?.... Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes No
Proof of citizenship or immigration status will be required upon employment.
Date available for work:
What is your desired rate of pay?

Are you available to work:
  • Part Time Weekend Day Shift (6am to 6:30pm - Saturday - Sunday)
  • Part Time Weekend Night Shift (6pm to 6:30am - Saturday - Sunday)
  • First Shift (6am to 4:30pm - Monday to Thursday, and occasional Fridays)
  • Night Shift (4:30pm to 3:am - Monday to Thursday, and occasional Fridays)
  • Weekend Day Shift (6am to 6:30pm - Friday - Saturday - Sunday)
  • Weekend Night Shift (6pm to 6:30am - Friday - Saturday - Sunday)
  • Distribution (6am to 4:30pm - Tuesday to Friday)
  • Office (8am to 5pm - Monday to Friday)

Education

  Name of School
& Address
Major/Degree Years Completed Diploma
Degree
Grammar
High
School
College
Trade /
Correspondence
(Field boxes can be resized by dragging lower right corner of each.)

Employment Experience

Please list your work experience for the past five years, beginning with your most recent job held. If you were self-employed give firm name.

Job 1

Employer:
Address:
Phone Number:
Job Title:
Reason for Leaving:
Hourly rate/Salary:
Dates Employed:

Work Performed

Job 2

Employer:
Address:
Phone Number:
Job Title:
Reason for Leaving:
Hourly rate/Salary:
Dates Employed:

Work Performed

Job 3

Employer:
Address:
Phone Number:
Job Title:
Reason for Leaving:
Hourly rate/Salary:
Dates Employed:

Work Performed

Which of these jobs did you like best?
What did you like most about this job?

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

References


Not including former employers or relatives.

Reference 1

Name:
Address:
Occupation:
Phone Number:

Reference 2

Name:
Address:
Occupation:
Phone Number:

Reference 3

Name:
Address:
Occupation:
Phone Number:
In case of emergency please contact the following individual:
Name: Address: Phone:

Acknowledgement

I certify that answers given herein are true and complete to the best of my knowledge.

I hereby authorize investigation of all statements contained in this application and agree that if any misrepresentation has been made by me herein or the results of an investigation are not satisfactory for any reason, any offer of employment made to me may be terminated immediately without any obligation or liability to me other than for payment, at the rate agreed upon, for services actually rendered if I have been employed.

In connection with my application for employment, I authorize AJ Manufacturing Inc., and any agent acting on its behalf, to conduct an inquiry as to my record of any or all of my former employers, references, and any or all educational institutions. Moreover, I hereby release AJ Manufacturing, and any agent acting on its behalf, from any and all liability of whatsoever nature by reason of requesting such information from any person.

I understand that I am required to abide by all rules, policies and regulations of the company.

I understand that this application is not and is not intended to be a contract of employment.

I acknowledge that I have read and understand the foregoing.

I, acknowledge that I have read and understand the applicant statement.