Contact Information

Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Email Address *

How would you prefer to be contacted? *

Personal Questions

Are you 18 years or older? *YesNo

Do you have reliable transportation? *YesNo

Have you previously applied to or worked for Midwest Tool? *YesNo

If selected for employment are you willing to submit to a pre-employment drug screening? *YesNo

Are you a U.S. Citizen? *YesNo

Have you ever been convicted of a felony? *YesNo

Are you applying for first or second shift? (If you have no preference, put 'Either') *

Who were you referred by?

Tell us a little about yourself (hobbies, interests, etc.):

Education

High School

Did you graduate?YesNo

Highest level completed:

College

Did you graduate?YesNo

Major or Studied Subject

Vocational Trade School

Did you graduate?YesNo

Major or Studied Subject

Employment History

Employer One

Employed From Date

Employed To Date

Supervisor's Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Work Phone

May we contact them?YesNo

Pay Rate

Position

Duties

Reason for Leaving

Employer Two

Employed From Date

Employed To Date

Supervisor's Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Work Phone

May we contact them?YesNo

Pay Rate

Position

Duties

Reason for Leaving

Employer Three

Employed From Date

Employed To Date

Supervisor's Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Work Phone

May we contact them?YesNo

Pay Rate

Position

Duties

Reason for Leaving

References

Reference One Name

Reference One Phone

Reference One Relationship

Reference Two Name

Reference Two Phone

Reference Two Relationship

Reference Three Name

Reference Three Phone

Reference Three Relationship

Legal

I certify that all answers given are true and complete to the best of my knowledge. *Yes

I authorize investigation of all statements contained in this application for employment as may be necessary for arriving at an employment decision. *Yes

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. *Yes

Signature *

Today's Date *

Material Handler

Material Handler

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