03/09/10
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Are you a Student
Yes     No
Do you have use of an auto?
Yes     No
Are you on a bus line?
Yes     No
Yes     No
Yes     No
mm/dd/yy
M T W T
F S S
Yes     No
Yes     No
Yes     No
1.
2.
3.
Yes   No
Yes   No
Yes   No
Yes   No
    Please complete the below skills checklist. Select 1, 2 or 3 on ONLY those skills that apply to you.

    (1 = GOOD, 2 = AVERAGE, 3 = POOR)

   

Plant Maintenance

   1     2      3     none
  Carpentry
  Electrical
  Elec. License
  Heat/Vent/AC
  Machine Maint.
  Machine Repair
  Painting
  Plumbing

Other:
Other:

Quality Control

   1     2      3     none
  Chemical Inspection
  Electrical Inspection
  First Piece
  Layout Inspection
  Metallurical
  M D T
  Parts Inspection
  Testing Mech.

Other:
Other:

General Labor

   1     2      3     none
  Auto Repair
  Blueprint Read
  Cashier
  Food Handling
  Janitorial
  Landscape
  Material Handling
  Packing/Shipping
  Retail
  Security
  Yardwork
  Warehouse Per.

Other:
Other:



Assembly

   1     2      3     none
  Electrical
  Mechnical
  Packing
  PC Board
  Soldering
  Wire Harness

Other:
Other:

Machine Operations

   1     2      3     none
  Bridgeport
  C N C
  Drilling
  Extrusion
  Foam
  Footpress
  Grinding
  Injection Mould
  Lathe
  Milling
  Number Cont.
  Coating
  Polishing
  Punch Press
  Setup
  Woodcutting

Other:
Other:
Other:
Other:



Paper Printing

   1     2      3     none
  Artist
  Bindery/Booking
  Camera Operator
  Collator Operator
  Layout/Design
  Paste-Up
  Press Operato
  Press Helper
  Sewing/Stitch
  Silkscreen
  Typesetting
  Compugraphic
  Mergenthaler
  Purup
  Laser

Other:
Other:
Other:
Other:

Skill Trade

   1     2      3     none
 Arc Welding
  Blueprint Read
 Cutter/Grinder
 MIG
  Mouldmaker
  Sheetmaker
  T I G
  Tool Maker

Other:
Other:
Other:

Textile

   1     2      3     none
  Carding/Comb.
  Cutter
  Knitting
  Puch/Cut/FOR
  Sewing
  Twist/Beam/WR.
  Weaving

Other:
Other:
Other:

Driving

   1     2      3     none
  Delivery Van
  Tractor/Trailer
  Grading Equipment

  Licensed for:
CLASS I CLASS II none

Other

Fork Lift Operator

   1     2      3     none
  Gas
  Electric
  Propane
  Stand-Up
  Set-Down
  Computerized

  Certified? Yes No

Other:

Technical

   1     2      3     none
  Mechnical Licen.
  Electrical Licen.
  Chemical Licen.
  Pesticide Licen.

Other:



AUTHORIZATION

By initialing here I agree that I have been informed of the requirements of the work for which I am applying, and that the information on the application is correct and complete to the best of my knowledge. I understand that it shall be grounds for immediate dismissal if any of the information contained herein is found to be untrue. I authorize you and all former employers, given by me as references, to answer all questions and to give all information in connection with this application for in, any way concerning me. I understand that if accepted for employment I will be working for you, on your payroll, at your clients premises. I agree that I will obtain your permission before discussing permanent employment with your client. I agree to immediately notify you at the conclusion of each assignment or as soon as I become available. If I fail to give such notice, you may assume that I am not available for re-assignment, and am not ready, willing and able to work. I understand that any information I learn while working for a client is the be kept confidential. I agree to take a drug & alcohol test if I have a workman's comp injury while your employee. I agree if employed by you, that if i ever make claims against you for personal injuries, upon your request I shall submit to examinations by physicians of your selection. I will hold you harmless from any claims including, but not limited to, personal injury or illness as a result of my providing false or misleading information on this application. I hereby acknowledge that my employment is "at will", that I may resign at any time and the company may terminate my employment at any time, with or without cause.



 
 
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