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Name*:
Last Name*:
Application for employment
PERSONAL INFORMATION
Middle Name:
Street Address*:
City*:
Zip Code*:
Cell Phone*:
Home Phone:
E-mail address:
How did you hear about EMB Solutions?:
Are you legally eligible for employment in the U.S.?
Are you 18 years of age?
Have you ever been convicted of a felony?
If so please explain when you were convicted and the nature of the charge:
Would you agree to take a test for illegal drugs if such a test was a condition of employment?
Are you a veteran of the U.S. Armed Forces?
Do you have any medical conditions that would prevent you from performing a certain job?
If so, describe the functions that cannot be performed:
EMPLOYMENT AND AVAILABILITY
Position desired*:
Minimum acceptable pay rate $*
Desired pay rate $
Date you can start*:
Would you take short-term assignments (or part-time jobs)?
Are you currently employed?
What type of employment are you looking for?
What means of transportation do you have?
Maximum miles acceptable to travel for work?
EDUCATION
Company Name:*
Address:
Position:
Job duties:
Supervisor's Name:
Phone number:
May we contact this employer?
If not, please explain:
Employment dates:*
from:
to:
Salary/Hourly wage:
starting $
ending $
Reason for leaving:*
Employment gap of more than 3 months (if any), please fully explain:
Company Name:*
Address:
Position:
Job duties:
Supervisor's Name:
Phone number:
May we contact this employer?
If not, please explain:
Employment dates:*
from:
to:
Salary/Hourly wage:
starting $
ending $
Reason for leaving:*
Employment gap of more than 3 months (if any), please fully explain:
Company Name:*
Address:
Position:
Job duties:
Supervisor's Name:
Phone number:
May we contact this employer?
If not, please explain:
Employment dates:*
from:
to:
Salary/Hourly wage:
starting $
ending $
Reason for leaving:*
Employment gap of more than 3 months (if any), please fully explain:
REFERENCES*
Give below the name of two professional references, whom you have known for at least one year
Name
Phone number
Business
Years of acquaintance
Date:
* = required field
WORK EXPERIENCE
Put a checkmark next to any area in which you have skills and also the amount of experience you have with each skill.
CONSTRUCTION
Yrs Exp.
DRIVERS
ELECTRICAL/MECH. ASSEMBLY
FORKLIFT
GENERAL LABOR
PRODUCTION
MACHINE OPERATOR
Yrs Exp.
MAINTENANCE
Yrs Exp.
WAREHOUSE
PC OPERATION
Have you held any of these positions?
Please select your highest level of education.
Degree received, if applicable.
Please select the shift(s) for which you are available.
If you are looking for a part-time please select your preference
EMPLOYMENT HISTORY (Please include your 3 past employers.) *
