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West Central Minnesota

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Personnel
Today's Date
First Name  
  
Middle Name
Last Name
Nickname
Street Address
City
State
Zip
E-mail
Home Phone
Other Phone
Emergency Contact:
Emergency Phone
General Information
Type of work desired
General Labor Farm Labor Hospital
Office Services/Clerical Marketing / Sales Professional Light Industrial Heavy Industrial Technical / Engineering
Are you willing to work in a smoking environment?
No Yes
What is your lifting capacity?
10 lbs 25 lbs 50 lbs 80 lbs 100 lbs 100+ lbs
Drivers License Issuing State
Drivers License Number
Are you willing to take a drug test?
No Yes
Any history of legal convictions? (if yes please explain)
No Yes
Are you a veteran?
No Yes
Have you ever been bonded?
No Yes
Date
Details
Availability
First Date Available
Last Date Available
Wage / Salary Required
Number of hours preferred per week
How far are you willing to travel?
How are you planning on getting to work?
How much notice do you require to begin employment?
Same Day One Day Two Days One Week Two weeks One month
Preferred assignment duration
Long term Short term
Are you willing to work overtime?
No Yes
Are you a student?
No Yes
Are you on layoff / recall?
No Yes

Please select shift preference (1st, 2nd, 3rd)
Indicate days of week available with an "X"
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

High School
Name of Institution
City / State
Degree Type
Diploma G.E.D.
Major / Study
Did you graduate?
No Yes
College or Technical School
Name of Institution
City / State
Degree Type
Major/Study
Dates Attended From
Did you graduate?
No Yes
College or Technical School
Name of Institution
City / State
Degree Type
Major/Study
Dates Attended From
Did you graduate?
No Yes

Employment History (start with most recent employer)

Past Employer #1
Company Name
City / State
Phone Number
Job Title
Starting Pay
Ending Pay
Starting Date (month/year)
Ending Date (month/year)
Did you work?
Part Time Full Time
Job Description
Supervisor's Name
Reason For Leaving
May we call this employer for a reference?
No Yes
Past Employer #2
Company Name
City / State
Phone Number
Job Title
Starting Pay
Ending Pay
Starting Date (month/year)
Ending Date (month/year)
Did you work?
Part Time Full Time
Job Description
Supervisor's Name
Reason For Leaving
May we call this employer for a reference?
No Yes
Past Employer #3
Company Name
City / State
Phone Number
Job Title
Starting Pay
Ending Pay
Starting Date (month/year)
Ending Date (month/year)
Did you work?
Part Time Full Time
Job Description
Supervisor's Name
Reason For Leaving
May we call this employer for a reference?
No Yes
References
Personal or Professional References
1. Name Relationship Phone
2. Name Relationship Phone

Job Related Skills

Business / General Office (Select if you have 3+ months experience)

Accounting / Finance Computer Software/Hardware General Sales Miscellaneous

Accounts Receivable

Microsoft Office

SQL Server

Telephone Lines

Inside Sales

Bilingual

Accounts Payable

Word

Oracle

Data Entry

Outside Sales

Payroll

Excel

Visual C++

Typing WPM:

Telemarketing

Human Resources

Accounting Software PowerPoint Visual Basic Legal Secretary

Retail

Insurance

Email

Windows NT Server

Medical Secretary

Customer Service

Legal

Banking

Internet

Novell Netware

Receptionist

 

Management

Mortgage Lending

Graphics

Unix

Teller

  Teaching

Industrial / Technical / Other (Select if you have 3+ months experience)

General Labor Drafting Food Service Maintenance Plumber
Assembly Line     AutoCAD Restaurant Masonry Route Driver / Delivery
    Inspection Electrician     Cooks Auto Mechanic Warehouse
Packaging     Electrician Apprentice     Dishwasher Diesel Mechanic Welder
Carpenter     Journeyman     Manager Metal Fabrication Certified Welder
    Carpentry Experience Electronic Technician     Wait staff Painter Type
    Framing Engineer Cashier Print Shop C.N.A.
Sheetrock Farm Labor Forklift Security Lab Technician
Construction     Dairy     Certified Shipping & Receiving Other
    Roofing     Poultry Janitorial Truck Driver  
    Residential     Swine Machine Operator     Class A  
    Commercial     Grain Machinist Landscaper  
        CNC    

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be ground for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, 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 prior notice.

Date: Name:

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