Employment Application "*" indicates required fields Name* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* When is the best time to call?* Morning Afternoons Evening Anytime Date you are available to start working?* MM slash DD slash YYYY How did you hear about Machine Service Inc?Select Your Shift Preferences1st Shift I would Prefer I would Accept 2nd Shift I would Prefer I would Accept Minimum Pay Rate*Position Applying For:*Other PreferencesRepetitive Lifting* Yes No Light Lifting (1-12 lbs.)* Yes No Medium Lifting (13-30 lbs.)* Yes No Heavy Lifting (31 - 50 lbs.)* Yes No Extreme Heavy Lifting (51+ lbs.)* Yes No Prolong Sitting* Yes No Prolong Standing* Yes No Repetitive Bending* Yes No Repetitive Hand/Eye Coordination* Yes No Blue Print Reading* Yes No Measuring Device Usage* Yes No Basic Shop Math* Yes No Basic Computer Usage* Yes No EducationHigh School Name & Location# of Years CompletedGED or GraduateCourse of StudyDegree AttainedCollege/Tech School Name & Location# of Years CompletedDid you graduate? Yes No Course of StudyDegree AttainedCollege/Tech School Name & Location# of Years CompletedDid you graduate? Yes No Course of StudyDegree AttainedOther Education Name & Location# of Years CompletedDid you graduate? Yes No Course of StudyDegree AttainedAny Additional Eductaion CommentsEmployment HistoryList names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give company names. PLEASE GIVE MONTH AND YEAR.May we contact your present employer(s)? Yes No Your Last or Present Employer's NamePhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date of Employment MM slash DD slash YYYY End Date of Employment MM slash DD slash YYYY Starting Rate/SalaryFinal Rate/SalaryJob DescriptionReason for LeavingEmployer NamePhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date of Employment MM slash DD slash YYYY End Date of Employment MM slash DD slash YYYY Starting Rate/SalaryFinal Rate/SalaryJob DescriptionReason for LeavingEmployer NamePhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date of Employment MM slash DD slash YYYY End Date of Employment MM slash DD slash YYYY Starting Rate/SalaryFinal Rate/SalaryJob DescriptionReason for LeavingEmployer NamePhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date of Employment MM slash DD slash YYYY End Date of Employment MM slash DD slash YYYY Starting Rate/SalaryFinal Rate/SalaryJob DescriptionReason for LeavingAre you 18 years of age or older?* Yes No Have you ever been employed by Machine Service Inc in the past?* Yes No When did you work at Machine Service?PositionSupervisorAre you currently on "lay-off" status and subject to recall? Yes No Can you travel if the job requires? Yes No Provide actual months worked on the following machines:Boring BarDrill PressEngine LatheMilling MachineCNC MachineWhat type of CNCAssembly ExperienceState any additional information you feel may be helpful to us in considering your applicationList professional, trade, business or civic activities and offices held. (You may exclude memberships which would reveal sex, race, religion, national orgin, age, ancestry, or handicap or other protected characteristics)ReferencesName* First Last Phone*This Reference is* Business Personal Name* First Last Phone*This Reference is* Business Personal Name* First Last Phone*This Reference is* Business Personal Name* First Last Phone*This Reference is* Business Personal Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*Proof of citizenship or immigration statues will be required upon employment. Yes No Have you ever been convicted of a crime?* Yes No A conviction will not be an automatic bar from employment, and such a conviction will only be considered as it relates to the duties of the jobs for which you are applying. Per the State of Illinois, you are not obligated to disclose sealed or expunged records of conviction or arrest and you may not be asked about such records.If yes, please list dates and explain the circumstances related to the convictionDigital SignatureI certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed in this job application.Date* MM slash DD slash YYYY Please Type Your Name*Digital SignatureNameThis field is for validation purposes and should be left unchanged.
