Employment Application Date First Name Middle Initial Last Name Address City State Zip Phone Email Date Available Last Four of SSN Position Applied For Are you 18 years or older? Yes No Have you previously worked for this company? Yes No If Yes, When? Are you a citizen of the U.S.? Yes No If No, are you authorized to work in the U.S.? Yes No If yes, when? Have you ever been convicted of a felony? Yes No If yes, explain: I understand that my employment will be determined based on the results of a drug screen prior to beginning work. Also, I understand that a random drug screen will be given during the year and a post accident drug test if I am injured on the job. Education Level Years Attended Name of School City, State Course Did you graduate? Grammar School Yes No High School Yes No College Yes No Other Yes No Experience Company Name Company Address Start Date End Date List Your Duties Reason for Leaving Add Row Professional References Name Address Occupation Add Row I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.