Midwest Prefinishing Application

Application for Employment

Midwest Prefinishing, Inc. is an equal opportunity employer and does not discriminateagainst otherwise qualified applicants on the basis of any characteristic protected by law,including race, color, religion, age, sex, national origin, or disability.

Which position are you applying for?*

Your Contact Information

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

E-mail Address

Home Phone

Mobile Phone

Social Security Number

Are you over 18 years old?

YesNo

Do you hold a Valid Drivers License?

YesNo

Do you hold a CDL?

YesNo

If Yes,

AB

Are you eligible for employment in the United States?

YesNo

(If offered employment, you will be required to provide documentation to verify eligibility.)

During the last 10 years, have you been convicted of a crime other than a minor traffic offense?

YesNo

(A conviction will not necessarily automatically disqualify you for employment. Rather,such factors as your age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)

Can you pass a drug test?

YesNo

Can you with or without reasonable accommodation perform the essential functions of this job?

YesNo

Employment

May We Contact Your Current Employer

YesNo

Employer

Address

E-mail Address

Position

Date of Employment: From

Date

Date of Employment: To

Date

Starting Salary

Ending Salary:

Supervisor

Full TimePart Time

Duties

Reason for Leaving

Employer

Address

E-mail Address

Position

Date of Employment: From

Date

Date of Employment: To

Date

Starting Salary

Ending Salary:

Supervisor

Full TimePart Time

Duties

Reason for Leaving

References

First Name

Last Name

E-mail Address

Phone

First Name

Last Name

E-mail Address

Phone

First Name

Last Name

E-mail Address

Phone

FAQ"s

Past relative jobs and machine experience ?

What are you looking for in a job-what’s important?

How can you contribute to Midwest Prefinishing?

I hereby certify that the facts set forth in the above employment application are true andcomplete to the best of my knowledge and authorize Midwest Prefinishing, Inc. to verifytheir accuracy and to obtain reference information on my work performance. I herebyrelease Midwest Prefinishing, Inc. from any/all liability of whatever kind and nature, which, atany time, could result from obtaining and having, an employment decision based on suchinformation. I understand that, if I am employed by Midwest Prefinishing, Inc., falsified statements of anykind or omissions of facts called for on this application shall be considered sufficient basis fordismissal. I authorize Midwest Prefinishing, Inc. to make a thorough investigation of allstatements contained in this application about my past employment, education, and otheractivities. I release from liability all persons and organizations supplying such information.

E-Signature of Applicant

Date