General Application

Personal

I am authorized to work in the United States *

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Address *

Do you know of any reason why you cannot perform the essential functions of the job for which you are applying with or without reasonable accommodations? *

If Yes, Explain

General

Position Or Type Of Work Desired *

Date Available

How Were You Referred To Automation Tool & Die? *

Do You Have Relatives/Friends Employed By Automation Tool & Die? *

If Yes, Give Name(s)/Relationship(s)

Have You Ever Applied To Automation Tool & Die Before? *

If Yes, when?

Have You Ever Been Employed By Automation Tool & Die? *

If Yes, List Positions and Dates

Employment Status Desired *

1st Shift

2nd Shift

3rd Shift

Full-Time

Part-Time

Temporary

Summer

If necessary, are you able to work overtime? *

If necessary, are you able to work weekends? *

Are you willing to submit to a pre-employment drug-screening exam? *

Have you been convicted of a felony or released from prison within the last seven (7) years? *

If yes, state date and nature of conviction

List any industrial machinery, offce equipment or computers you can operate: *

Special Skills *

Other *

Education

	Name	City	State	Did you graduate?	GPA	Degree or Specialization
High School
College
Vocation/Trade School
Other

Do you have a G.E.D.? *

Future Educational Plans *

Military Service

Have you ever been in the U.S. Armed Forces or Reserves? *

Are you presently in the Active Reserves? *

Training Received *

Duties *

Employment History

Instructions: Beginning with the present or most recent employer, list all employers for whom you have worked. Please enter all information, even when submitting a resume. Check the numbers of any employers whom you do not want to be contacted for reference

Employer 1
Start Date End Date Reason for leaving Describe Job Duties
Employer 2
Start Date End Date Reason for leaving Describe Job Duties
Employer 3
Start Date End Date Reason for leaving Describe Job Duties
Employer 4
Start Date End Date Reason for leaving Describe Job Duties
Employer 5
Start Date End Date Reason for leaving Describe Job Duties
Employer 6
Start Date End Date Reason for leaving Describe Job Duties

Talent Summary

List personal strengths and abilities you bring to your employer *

List the weaker areas you are working to improve upon *

Which of your current (or most recent) job activities do you most enjoy? Why? *

Which of your current (or most recent) job activities do you least enjoy? Why? *

What talents and characteristics are necessary for a person to be most successful in your field? *

What do you hope to fnd in your current (or next) position and company affliation? *

Additional Remarks *

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