Employment Application

		Personal Information
Name*
Address
City
State
Zip Code
Phone
E-Mail*
SSN
		Person to Contact in Case of Emergency
Contact Name
Address
City
State
Phone Number
Relationship
		Education
High School		Did You Graduate? No Yes
College/Trade School		Did You Graduate? No Yes
Courses & Degree
		Employment History Please list the last 3 jobs if less than 5 years with the most recent first
Company Name
Staffing Agency		Temp Perm
Title
Salary
Start Date
End Date
Duties
Supervisor
Phone
Reason for Leaving
Company Name
Staffing Agency		Temp Perm
Title
Salary
Start Date
End Date
Duties
Supervisor
Phone
Reason for Leaving
Company Name
Staffing Agency		Temp Perm
Title
Salary
Start Date
End Date
Duties
Supervisor
Phone
Reason for Leaving
		Skills Check all that apply
Computer Skills		Windows AS400 Word Excel Other
Electronic Assembly		Blueprints Cabling Color Code Component ID Harnessing Kit Puller Multi-Layer PC Board - MFG. Other
Forklift		Certified Gas Electric Stand Up Sit Down       Other
Additional Computer Skills		Clean Room Rate/Paced
Production		Shared Workstation Work Alone Works With Others   Other
Gardening/Landscaping		General Laborer Inventory Counter Janitor Material Handler Picker/Packer Production Worker Stock Room Swamper Wait Person Warehouse Worker
Industrial		Mender Roll-Up Binder Creeler Inspector Sew-On Serger
Inspector		Final In-Process/Line Lead Quality Control Receiving
Machine Operator		Drill Press Injection Mold Lathe Mill Punch Press Sander Setups Twister Winding Spinning Band-Saw Brake-Press Extrusion
Mechanical Assembly		Blue Prints Drawings PC Board Sanding Schematics Tools - Hand Tools - Power Has Own Tools Trainee
Mirco		Capping Die Attach Thick Film Water Fab Wire Bonding
Shipping & Receiving		Fed Ex UPS
Testing		Calipers Measuring Devices Micrometers O-Scopes Ohm Meter
		Trades Check all that apply
Carpenter		Appren. Journ.
Electrician		Appren. Journ. Handyman Maint. Mechanic
Painter		Exterior Interior Industrial Autobody
Plumber		Appren. Journ.
Welding		Mig Tig Stick Robotics
		* Required

APPLICATION DISCLOSURE STATEMENT: By submitting this application, you hereby declare that all statements contained in this application are true and correct to the best of your knowledge and you understand that false or inaccurate information in the application will be the basis for termination. You hereby authorize this company to investigate your background and verify this information. You understand that your failure to report to work will indicate that you have quit.

By Mail: CORPORATE OFFICE 5625 North Henry Blvd. Suite A Stockbridge, GA 30281

By Phone: 678.289.2310 fax 678.289.2317

Click here to download a PDF version of this employment application