JR. SHORT MILLING COMPANY
APPLICATION FOR EMPLOYMENT

Personal Information

First Name
Middle Initial
Last Name
Street Address
City, State
,
Zip
Phone#
Email Address
 
SSN#
Drivers License#
State

I AM A U.S. CITIZEN OR OTHERWISE AUTHORIZED TO WORK IN THE UNITED STATES ON AN UNRESTRICTED BASIS:
Yes   No
IF APPLICABLE, PLEASE LIST YOUR VISA TYPE, VISA#, AND EXPIRATION:  

HAVE YOU EVER BEEN CONVICTED OF A FELONY:   Yes No
IF YOU ANSWERED YES, PLEASE EXPLAIN:

Employment History

(Please enter employers from most recent to least)
Employer
Address
 
Your Position
Salary
 
Duties
Dates Of Employment
to
Supervisor Name
Title
 
May We Contact:   Yes   No
Reason(s) for leaving

Employer
Address
 
Your Position
Salary
 
Duties
Dates Of Employment
to
Supervisor Name
Title
 
May We Contact:   Yes   No
Reason(s) for leaving

Employer
Address
 
Your Position
Salary
 
Duties
Dates Of Employment
to
Supervisor Name
Title
 
May We Contact:   Yes   No
Reason(s) for leaving

Education

HIGHEST LEVEL OF EDUCATION
High School   Bachelors   MA   PHD  

High School

Name
Address
Did You Graduate   Yes  No
Attended From
to
If you are not a graduate, did you recieve your GED? Yes No
Special Honors Or Awards

Technical or Vocational School

Name
Address
Did You Graduate   Yes  No
Attended From
to
Degree Or Certification
Specialty
 
Special Honors Or Awards

College Or University

Name
Address
Did You Graduate   Yes  No
Attended From
to
Degree
Major
 
Special Honors Or Awards

Other

Name
Address
Did You Graduate   Yes  No
Attended From
to
Degree
Major
 
Special Honors Or Awards

Position Information

How Did You Learn About The Job?
What hours are you willing to work?
Would you be able to work weekends? Yes   No
Would you be willing to work overtime? Yes   No
When would you be able to start?
Salary Desired
Please Describe Any Skills Or Abilities You Have
 
By checking this box, you verify that the information given by you in this application is true, accurate and complete. You understand that if you have given any false information on this application, or if you have omitted any material facts, you may be disqualified from employment with the company, or if hired, you may be discharged immediately upon discovery of such false statements.