Material Handler, 1st shift - Fremont, NE

Today's Date

Position Applied For*

Position Location*

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone

Have you worked for Southwark Metal before?

Yes

When

Location

Do you have any friends/relatives working for Southwark Metal currently?

Yes

If so, please list their names:

How did you find out about this employment opportunity with Southwark Metal?

Can you Work when Needed?

Any Shift?

Yes

Overtime?

Yes

Weekends?

Yes

Which shift would be your preference to work?

First Shift

Second Shift

Swing Shift

No Preference

Explain:

Can you perform the essential functions of the position for which you are applying?

Yes

Explain:

Date available to start

Salary or hourly rate requested

If you are under the age of 18, do you have employment/age certificates?

Yes

Are you a United States Citizen, or otherwise authorized to work in the United States on an unrestricted basis?

Yes

Dates Attended

Special Skills or Training

Please summarize any skills or training you may possess

Military History

Any previous military experience?

Yes

Please List Details (Rank, Branch, Military Specialty, Date of Discharge)

*Note - A dishonorable discharge will not constitute an automatic bar to employment

Have you ever been convicted of a criminal offense?

Yes

*Note - Conviction will not necessarily disqualify an applicant for employment

Do you have prior experience working in the United States?*

Yes

Explain

Education

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There are no Education.

Fill out a section for each level of education.

Employment History

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There are no Employment.

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Employment Acknowledgement

Please read & accept the following: Southwark Metal Mfg. Co. Is an equal opportunity employer, and all employment decisions are made without regard to race, color, religion, sex, national origin, age, veteran status, disability, union affiliation (if any), or any other categories protected by federal, state, or local law. No question on this application is intended to secure information to be used for such discrimination. I consent to take the physical examination and drug/alcohol screen, and any future physical examinations and drug/alcohol screens, as Southwark Metal Mfg. Co. may designate. I understand that an offer of employment may be contingent on passing the physical examination and drug/alcohol screens which relates to the essential duties I would be required to perform. I authorize Southwark Metal Mfg. Co. to fully investigate my work record and qualifications either before or after my employment. I hereby authorize all previous employers and educational institutions to release, to Southwark Metal Mfg. Co., any information it may request. I certify that all statements made by me on this application are true and correct to the best of my knowledge, and are a full and complete disclosure. I further agree that if employed, any misrepresentation, falsification, or omission of facts shall justify my dismissal. I understand and agree that all products and results ofwork I perform in the course of my employment shall be the sole property of Southwark Metal Mfg. Co. I will be required to complete an EMPLOYMENT VERIFICATION FORM (I9) ·and within three (3) days show satisfactory evidence of identity and eligibility for employment.

Certification - Best of Knowledge*

I certify that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge.

Date

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Material Handler, 1st shift – Fremont, NE

Can you Work when Needed?

Employment Acknowledgement

Dates Attended:

Length of Service