Employment Application Personal InformationName* First Middle Last Your Email Address Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Position Applied For:* Date Available to Start* MM slash DD slash YYYY Salary Desired:* Type of Employment Desired:* Full-Time Part-Time Temporary Are You Employed Now?* Yes No May We Contact Your Present Employer?* Yes No Have You Ever Worked For This Company?* Yes No Dates Employed: Position: Reason for Leaving: Are You Legally Eligible for Employment in the United States?* Yes No Are 18 Years or Older?* Yes No Educational BackgroundHigh SchoolHigh School Name & Location High School Years Completed Did You Graduate? Yes No Course of Study CollegeCollege Name & Location College Years Completed Did You Graduate? Yes No Course of Study OtherOther Name & Location Other Years Completed Did You Graduate? Yes No Other Course of Study Additional Skills / Training / ExperienceSpecial / Job-related skills or qualificationsMilitary Service: Yes No Military Branch: Rank: Present Membership in National Guards or Reserves: Work ExperienceList your last three (3) employers starting with the most recent oneEmployer 1Company 1 Name Company 1 Address Company 1 PhoneCompany 1 Job Title Company 1 Supervisor Employment DatesCompany 1 Employment Date From MM slash DD slash YYYY Company 1 Employment Date To MM slash DD slash YYYY Company 1 Hourly Rate/Salary Company 1 Reason for Leaving Company 1 ResponsibilitiesEmployer 2Company 2 Name Company 2 Address Company 2 PhoneCompany 2 Job Title Company 2 Supervisor Employment DatesCompany 2 Employment Date From MM slash DD slash YYYY Company 2 Employment Date To MM slash DD slash YYYY Company 2 Hourly Rate/Salary Company 2 Reason for Leaving Company 2 ResponsibilitiesEmployer 3Company 3 Name Company 3 Address Company 3 PhoneCompany 3 Job Title Company 3 Supervisor Employment DatesCompany 3 Employment Date From MM slash DD slash YYYY Company 3 Employment Date To MM slash DD slash YYYY Company 3 Hourly Rate/Salary Company 3 Reason for Leaving Company 3 ResponsibilitiesWork ReferencesReference 1Reference 1 Reference 1 Company & Title Reference 1 PhoneReference 1 Years Known Reference 2Reference 2 Reference 2 Company & Title Reference 2 PhoneReference 2 Years Known Reference 3Reference 3 Reference 3 Company & Title Reference 3 PhoneReference 3 Years Known AuthorizationAuthorization: I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorized investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing the same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.*I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorized investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing the same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice. I agree with the above statements 67749 Milco Industries, Inc. is an Equal Opportunity Employer