Date of Application August 27, 2008
Are you 18 years of age or older
(Required due to OSHA regulations)		 Yes    No
Position Applied For
Date You Can Start:
Wage Desired:
CONTACT INFORMATION  
E-mail Address:
Last Name:
First Name:
Middle Initial:
Address (Number and Street):
Apt.
City:
State:
Zip Code:
Home Telephone Number:
(include area code)
Work Telephone Number:
(include area code)
Social Security Number:
Referral Source
SKILLS
Fabrication/Welding -Please select the area(s) that you have experience in.
Welding - TIG Punch Press
Welding - MIG    Shear
Metal Sawing Machines    Saw Band
Brake Press    Forklift
   
Machining - Please select the area(s) that you have experience in.
  Drill Press CNC Equipment
  Lathes Quality Control
  Mill Metal Finishing
  Blue Print Reading
   
Office - Please select the area(s) that you have experience in.
Data Entry Office 97

Word Processing

Internet
Spreadsheets/Database Shop Management Software Systems
Switchboard Auto-Cad
   
Do you have a valid driver's license? Yes    No
Do you have a commercial driver's license? Yes    No
Has your driver's license been suspended or revoked in the last two years?

Yes    No


Explain in detail as to date, place, violation and disposition

Do you have a relative or friend employed here? Yes    No
Do you have a permanent work authorization in the United States Yes    No
Are you a veteran of U.S. Military Service? Yes    No

Have you been convicted of a felony, or released from prison in the past 10 years?

( Note: A yes answer does not automatically disqualify you since the nature of the offense, date and type of job for which you are applying will be considered.)

Yes    No

If yes, please explain.

REFERENCES - Do not include relatives.
Last Name:
First Name:
Address (Number and Street):
Apt.
City:
State:
Zip Code:
Telephone Number:
(include area code)
Relationship:
Years Known:
Last Name:
First Name:
Address (Number and Street):
Apt.
City:
State:
Zip Code:
Telephone Number:
(include area code)
Relationship:
Years Known:
Last Name:
First Name:
Address (Number and Street):
Apt.
City:
State:
Zip Code:
Telephone Number:
(include area code)
Relationship:
Years Known:

EDUCATION
High School Name:
High School Address:
High School Phone:

Did you graduate from High School?

 Yes    No
College/University:
College/University Address:
College/University Phone:

Did you graduate from College/University?

 Yes    No
Major
Trade/Business/Other School:
Trade/Business/Other School Address:
Trade/Business/Other School Phone:

Did you graduate from Trade/Business/Other School?

 Yes    No
Major
   
Other (specify):
Degree Obtained:

EMPLOYER
Employer Name:
Supervisor:
Phone Number:
Street Address:
City:
State:
Zip Code:
Began Employment:

Ended Employment:
Salary/Wage:
Reason for Leaving:
Job Title/Duties:

Employer Name:
Supervisor:
Phone Number:
Street Address:
City:
State:
Zip Code:
Began Employment:

Ended Employment:
Salary/Wage:
Reason for Leaving:
Job Title/Duties:

Employer Name:
Supervisor:
Phone Number:
Street Address:
City:
State:
Zip Code:
Began Employment:

Ended Employment:
Salary/Wage:
Reason for Leaving:
Job Title/Duties:
JOB-RELATED SPECIAL SKILLS, QUALIFICATIONS, AND TRAINING
Summarize other skills, qualifications and training acquired from employment or other experiences:



I declare that the information provided by me on this application and attached resume is complete and truthful. I also understand "that any misrepresentation or omission on this application may preclude an offer of employment, or may result in a withdrawal of an employment offer, or may result in my discharge from employment if I am already employed at the time the misrepresentation or omission is discovered.

Marchant Schmidt, Inc., is an at will employer. I agree that, just as I have, if hired, the right to terminate my employment at any time, with or without cause and with or without notice, the company may terminate my employment at any time with or without cause or notice. This application, nor any offer of employment from Marchant Schmidt, Inc., constitutes a contract of employment for a specified period of time unless a specific document to the effect is executed by Marchant Schmidt, Inc., President, and myself in writing.

By submitting this application online, I give Marchant Schmidt, Inc., authorization to investigate all statements and information contained within this application.

Full Name:
Today's Date: