Project Coordinator – geniuslifts

PERSONAL DATA

Last Name *

First Name *

Middle Name

Present Address

City, State, Zip

How Long?

Telephone

Cell Phone

Positions Applied For

Work Schedule Desired:

Full Time

Part Time

Rate Of Pay Expected:

Shift

How Did You Hear Of This Opening?

Have You Worked With Us Before?

Yes

When/How Long?

Previous Job Title

Reason For Leaving?

List Any Friends/Relatives Working With Us Now.

Are You Over 21?( If No, hire is subject to minimum legal age verification.)

Yes

Sex:

Male

Female

Height:

Feet

Inches

Weight:

LBS.

Martial Status:

Single

Married

Separated

Divorced

Widowed

Nnumber Of Years Married

# Of Dependents Including Self

Have You Ever Been Bonded?

Yes

WHEN?

If Yes, List Convictions And Status

If Yes, Describe:

Have You Ever Been Convicted Of a Crime In The Past 10 Years (Excluding Traffic Violations)?

Yes

Have You Had Any Serious Illness In The Past Five (5) Years?

Yes

EDUCATION HISTORY(START FROM MOST RECENT AND FILL IN AS MUCH AS HISTORY AS POSSIBLE):

1. Educational Benchmark:

Graduated:

Major:

Grade Point Average:

School Information:

Name:

Address:

Comments

3. Educational Benchmark:

Graduated:

Major:

Grade Point Average:

School Information:

Name:

Address:

Comments

4. Educational Benchmark:

Graduated:

Major:

Grade Point Average:

School Information:

Name:

Address:

Comments

5. Educational Benchmark:

Graduated:

Major:

Grade Point Average:

School Information:

Name:

Address:

Comments

Other certification, training or awards:

EMPLOYMENT EXPERIENCE:

Start with you present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status

1. Employer Information:

Name

Address:

Telephone Number

Job Title

Reason for Leaving

Date Employed:

From

Starting Salary (In Dollars($)):

Ending Salary (In Dollars($)):

Details on Experience:

2. Employer Information:

Name

Address:

Telephone Number

Job Title

Reason for Leaving

Date Employed:

From

Starting Salary (In Dollars($)):

Ending Salary (In Dollars($)):

Details on Experience:

3. Employer Information:

Name

Address:

Telephone Number

Job Title

Reason for Leaving

Date Employed:

From

Starting Salary (In Dollars($)):

Ending Salary (In Dollars($)):

Details on Experience:

4. Employer Information:

Name

Address:

Telephone Number

Job Title

Reason for Leaving

Date Employed:

From

Starting Salary (In Dollars($)):

Ending Salary (In Dollars($)):

Details on Experience:

5. Employer Information:

Name

Address:

Telephone Number

Job Title

Reason for Leaving

Date Employed:

From

Starting Salary (In Dollars($)):

Ending Salary (In Dollars($)):

Details on Experience:

PERSONAL REFERENCES (LIST ONLY PERSONS WE MAY CONTACT):

1. Name

Address

Relationship

Contact number:

Home

Work

Cell

2. Name

Address

Relationship

Contact number:

Home

Work

Cell

3. Name

Address

Relationship

Contact number:

Home

Work

Cell

4. Name

Address

Relationship

Contact number:

Home

Work

Cell

5. Name

Address

Relationship

Contact number:

Home

Work

Cell

EMPLOYMENT APPLICANT RELEASE AND CONSENT

The purpose of this release is to allow FABRICATORS, INC. (Hereafter referred to as “Company”), Application Researchers, or their assigns, to obtain pre-employment information which may include any lawful investigation of my educational background and criminal, driving, credit, and employment histories, while maintaining compliance with all governmental laws.

I am aware I have the right to make a written request of Application Researchers, P. O. Box 11, Chattanooga, TN 37401-0011, (423) 265-6035, to obtain additional information regarding the nature and scope of the background check.

If the company considers the background check results unfavorable, I agree that the company may deny me the assignment or discharge me from employment. I release the company, its officers, agents, and employees from all liability resulting from the collection, use or disclosure of the information obtained during the above investigation.

I certify that the information contained within the employment application is complete and true. I have read this release and consent, understand its terms, realize its significance, and sign it voluntarily.

I am willingly providing the following information necessary for the above investigation, and understand that this information is being used for verification purposes only.

(Please Print, except for requested signature)

Applicant’s Name

First Name

Middle

Last

SocialO Security Number

Driver’s License Details:

State

Number

Signature of Applicant(PRINT YOUR NAME)

Date