Today's date

YYYY

Name

(as it appears on your Social Security card)

First Name

Last Name

Present mailing address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email address

Phone number

Are you at least 18 years of age?

yes

Have you worked previously for Premier Tooling & Manufacturing Inc?

yes

If you answered "yes," what were the approximate dates?

EDUCATION

LIST EACH SCHOOL OR COLLEGE ATTENDED, MAJOR SUBJECTS OR COURSE WORK, YEARS ATTENDED, IF YOU GRADUATED, AND THE RESULTING DEGREE.

OCCUPATIONAL

THIS APPLICATION WILL BE CONSIDERED FOR ALL OPENINGS WITHIN THE JOB GROUP SELECTED. YOUR APPLICATION WILL BE FURTHER CONSIDERED IN OTHER AREAS BASED UPON COMPANY NEED AND YOUR LEVEL OF EXPERIENCE/TRAINING.

production worker (semi-skilled)

machine tool worker (skilled)

machinist

Can you use a micrometer?

yes

Can you read shop prints?

yes

Shifts willing to work

first

second

third

any

Expected rate of pay

REFERENCES

WORK HISTORY

GIVE DETAILS OF WORK EXPERIENCE, INCLUDING MILITARY SERVICE, APPRENTICESHIPS, SUMMER WORK, AND MISCELLANEOUS JOBS. LIST MOST RECENT WORK EXPERIENCE FIRST.

Length of employment

FROM

Describe your position and duties, including wage or salary and reason for leaving.

May we contact this employer for reference?

yes

Length of employment

FROM

Describe your position and duties, including wage or salary and reason for leaving.

May we contact this employer for reference?

yes

Length of employment

FROM

Describe your position and duties, including wage or salary and reason for leaving.

May we contact this employer for reference?

yes

Length of employment

FROM

Describe your position and duties, including wage or salary and reason for leaving.

May we contact this employer for reference?

yes

Have you ever signed a non-compete agreement?

yes

IF YOU ANSWERED YES, WHEN AND WITH WHOM?

CERTIFICATION STATEMENT

If an offer of employment is made, I agree to submit to pre-employment testing which includes a drug screen urinalysis for illegal drugs. If for any reason your sample does not conclusively meet sample standards, you may take one (1) retest at your own expense. Premier Tooling & Manufacturing, LLC. does agree to reimburse you for the test if it comes back negative for illegal drugs and you accept employment with Premier Tooling & Manufacturing Inc. The offer of employment will be withdrawn if the second drug screening is positive for illegal drug.

STATEMENT OF FACTS

I declare the foregoing to be to the best of my knowledge and belief an accurate statement of facts. It is understood that any false statements or omission of facts will be sufficient reason for dismissal. In making this application for employment it is understood that an investigation may be made whereby information is obtained through personal interviews with your neighbors, friends, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics and mode of living.

Application for Employment

PLEASE fully COMPLETE THE FORM BELOW

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