Employment Application

APPLICATION FOR EMPLOYMENT
for the
Kern Glass & Aluminum Company


Applying for Position of:   Date:
Referral Source: AdvertisementFriendRelativeWalk-in

PERSONAL INFORMATION


Last Name:
  First Name:
  Middle Name:
Address:
  City:
  State:
  Zip Code:
Phone Number:
  Social Security Number:
  Drivers License Number:
Have you filed an application here before? YesNo   If Yes, Give Date:
Do you wish to work: Full TimePart Time   Wages expected:
Are you employed now? YesNo   If Yes, may we contact your present employer? YesNo
Are you lawfully prevented from being employed in this country because of Visa or Immigration status? YesNo   (Proof of citizenship or immigration status will be required upon employment)
Date would you be available for work?   Are you on lay-off and subject to recall?: YesNo
Do you have any physical condition which may limit your ability to perform the job applied for? YesNo   If yes what specific impairment?
Have you been convicted of a felony in the last 7 years?
YesNo
  Will you undergo a pre-employment examination?
YesNo
Are any of your relatives and friends employed here?
YesNo
  Do you have your own glazing tools? YesNo
Have you served an apprenticeship? YesNo   Trade?    How Long?

Where?
     
Person to notify in case of emergency?    
Name:   Relationship:
Address:   City:   State:   Zip Code:
Phone Number:    

EMPLOYMENT HISTORY

Company Name:   Phone Number:
Address:   Employed (month and year): From: To:
Name of Supervisor:   Monthly Pay: Start: Last:
State Your Job Title & Describe Your Work:

  Reason For Leaving:
Company Name:   Phone Number:
Address:   Employed (month and year): From: To:
Name of Supervisor:   Monthly Pay: Start: Last:
State Your Job Title & Describe Your Work:

  Reason For Leaving:
Company Name:   Phone Number:
Address:   Employed (month and year): From: To:
Name of Supervisor:   Monthly Pay: Start: Last:
State Your Job Title & Describe Your Work:

  Reason For Leaving:
Company Name:   Phone Number:
Address:   Employed (month and year): From: To:
Name of Supervisor:   Monthly Pay: Start: Last:
State Your Job Title & Describe Your Work:

  Reason For Leaving:
WE MAY CONTACT THE EMPLOYERS LISTED ABOVE UNLESS YOU INDICATE THOSE YOU DO NOT WANT US TO CONTACT.  

DO NOT CONTACT

Employers No.(s):
Reason:

DRIVING RECORD

Please list any accidents and/or citations you have had in the last five years. If none, please write "none".

EDUCATION

School Name & Location Elementary School High School Undergraduate
College/University
Graduate/Professional
Years Completed 45678 9101112 1234 1234
Describe Course of Study/Major
Diploma/Degree
Describe any specialized training, apprenticeship, skills and extra-curricular activities
Describe any honors or awards you have received
State any additional information you feel may be helpful to us in considering your application

REFERENCES
Give name, address, and telephone number of three references who are not related to you and are not previous employers

Name Address Phone
1.
2.
3.
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