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Last Name: *

First Name: *

Middle:

Application for Position of:

Date Available

Phone: *

Address:

Address 2 (P.O. Box, Apt. # etc.):

City:

State:

Zip:

Mailing address, if different from above:

Email *

Types of Employment Preferred (Check more than one box if desired)

Permanent (Full Time)

Permanent (Part Time)

Temporary (Full Time)

Temporary (Part Time)

Do you have access to a car? *

Yes

(For some positions, a vehicle is required.)

Do you have a valid driver's license? *

Yes

Are you over age 18? *

Yes

Are you a U.S. citizen, or do you have an entry permit which allows you to work? *

Yes

Do you have a High School Diploma or a GED Equivalency? *

Yes

Name and Location of High School:

TRAINING BEYOND HIGH SCHOOL

(College or University, Nursing, Business College, or other schools you have attended.) Under credits earned, indicate Q for Quarter Hours and S for Semester Hours.

Advanced School History

List Dates Attended, Credits Earned, Major Field, GPA/Base, Degree (and Year), Conferred

Additional Education and experience

Describe any education or training you have had which is not covered above, such as vocational school, correspondence courses. service schools, in-service training, or volunteer work which you feel is relevant to the Job or Jobs for which you are applying. Also include relevant license or certificate. Be specific.

WORK EXPERIENCE:

Provide a complete description. This information will be used to determine if your application is accepted. Be Specific. Start with your most recent job. BE CERTAIN TO INCLUDE SERVICE IN THE ARMED FORCES. For part-time work, show the average number of hours per month. Indicate any changes in Job title under same employer as a separate position.

Employer:

Kind of Business:

Your Title:

Reason for Leaving:

Your Duties:

Total Time Employed: (Full time) (Part time)

From: (Month & Year) To: (Month & Year)

Check One:

Monthly Salary

Hourly Salary

If selected for employment are you willing to submit to a drug screen?

Yes

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Washburn Iron Works

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