CONTACT DETAILS

First Name

Middle Name

Last Name

Address

City

State

Zip Code

Email Address

Telephone

EMPLOYMENT

Are you presently employed?

Are you 18 years of age or older?

Are you authorized to work in the United States without sponsorship?

Do you have a reliable means of transportation to and from work?

Have you previously been employed at Ericco Manufacturing?

Have you ever been discharged or forced to resign from a position?

Are you able to stand/walk on concrete for an 8-10 hour shift?

Are you able to perform repetitive hand, wrist, and arm motion?

Are you able to lift 40 lbs without assistance?

Do you agree to a pre employment drug test?

Desired Employment Status

Desired Shift

Desired Earnings

EDUCATION

Highest Level of Education Less than High School
High School Diploma or Equivalent
Some College, No Degree
Postsecondary Certificate
Associate’s Degree
Bachelor’s Degree
Master’s Degree
Doctoral Degree

At what school did you complete this education?

Title of Certificate or Degree Achieved

MOST RECENT WORK EXPERIENCE

Company Name

Company Phone Number

Position Held

Start Date

End Date (leave blank if current position)

Full Name of Supervisor

Summary of Job Duties

Reason for Leaving

May we contact this employer for reference/verification purposes?

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