APPLICATION FOR EMPLOYMENT
******WE ARE A DRUG-FREE WORKPLACE******

DATE JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , 2006 SOCIAL SECURITY #

LAST NAME FIRST NAME MIDDLE

CURRENT ADDRESS:
STREET CITY STATE ZIP

PERMANENT ADDRESS:
STREET CITY STATE ZIP

TELEPHONE # REFERRED BY

ARE YOU 18 YEARS OLD OR OLDER?
YES
NO

ARE YOU AFRAID OF HEIGHTS?
YES
NO

CAN YOU WALK STEEL?
YES
NO

DO YOU HAVE ANY PROBLEMS WORKING AT NIGHT OR WORKING OUT OF TOWN?
(PROBATION, ETC)
YES
NO

IF YES, PLEASE EXPLAIN

POSITION DESIRED START DATE DESIRED SALARY

ARE YOU CURRENTLY EMPLOYED?
YES
NO

MAY WE CONTACT YOUR EMPLOYER?
YES
NO

EDUCATION

HIGH SCHOOL YEAR COMPLETED

DID YOU GRADUATE?
YES
NO

COLLEGE YEAR COMPLETED

TRADE, BUSINESS, OR CORRESPONDENCE SCHOOLS

JOB RELATED SKILLS (any certifications, driver's licenses, etc.)

FORMER EMPLOYERS

COMPANY INFORMATION (NAME, ADDRESS, PHONE)

DATES OF EMPLOYMENT
FROM TO

POSITION SALARY

REASON FOR LEAVING

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COMPANY INFORMATION (NAME, ADDRESS, PHONE)

DATES OF EMPLOYMENT
FROM TO

POSITION SALARY

REASON FOR LEAVING

========================================================================

COMPANY INFORMATION (NAME, ADDRESS, PHONE)

DATES OF EMPLOYMENT
FROM TO

POSITION SALARY

REASON FOR LEAVING

========================================================================

COMPANY INFORMATION (NAME, ADDRESS, PHONE)

DATES OF EMPLOYMENT
FROM TO

POSITION SALARY

REASON FOR LEAVING

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REFERENCES
LIST THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR

NAME, ADDRESS, & TELEPHONE NUMBER

NAME, ADDRESS, & TELEPHONE NUMBER

NAME, ADDRESS, & TELEPHONE NUMBER

AUTHORIZATION

I authorize investigation on all statements contained in this application. I understand that misrepresentation of information requested is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without cause, and without any previous notice.
I acknowledge that Custom Welding & Fabrication, Inc. is a drug-free workplace. If I am terminated within my 90 day probation period, I agree to reimburse Custom Welding & Fabrication, Inc. the fee for my pre-employment drug screening.

DATE SIGNATURE
(BY TYPING YOUR NAME IN THE BOX ABOVE, YOU ARE DIGITALLY SIGNING THIS APPLICATION)

EMAIL ADDRESS

IN CASE OF EMERGENCY, NOTIFY

Custom Welding & Fabrication, Inc. is an equal opportunity employer, dedicated to the policy of non-discrimination in employment on any basis, including race, color, age, sex, religion, handicap, or national origin.