Employment Application /

Today's Date


Date of Birth


First name *


Last name *


Home Address *


City *


State *

Zip Code *


Phone *


Fax


Email *


Portfolio website - if applicable            (example: LinkedIn)


Position you are applying for *


Salary requirements


When can you start?

Have you ever been employed with our company before? *
Yes No

Start Date

End Date

Previous Dept

Previous Superviosr

Do you have any friends or relatives employed with our company?
Yes No
Name

Relationship

Name

Relationship

Educational Background *
HS Diploma GED Trade School Associates Bachelors

Are you willing to relocate?
Yes No Not sure

EMPLOYMENT HISTORY

- List last 5 years of employment history

Company 1

Company Name

Job Description

Supervisor

Contact Number

Start Date

End Date

Reason for Leaving

May we contact this employer?
Yes No

Company 2

Company Name

Job Description

Supervisor

Contact Number

Start Date

End Date

Reason for Leaving

May we contact this employer?
Yes No

Company 3

Company Name

Job Description

Supervisor

Contact Number

Start Date

End Date

Reason for Leaving

May we contact this employer?
Yes No

Company 4

Company Name

Job Description

Supervisor

Contact Number

Start Date

End Date

Reason for Leaving

May we contact this employer?
Yes No

MILITARY HISTORY

Have you ever served in the United States Military?
Yes No
What military branch did you serve in?
Airforce Army Coast Guard Marine Corps Navy
Discharge date

Discharge Type


If hired, will you be able to show proof of eligibility to work
within the United States?
Yes No
If hired, you may be required to operate company vehicles.
Do you have a valid driver's license?
Yes No

Do you have any physical, mental, or medical condition which would
interfere with your ability to do the job for which you have applied
for, without reasonable accommodations? If yes, please describe below.


Have you ever been convicted of a misdemeanor or felony? *
If so, please list below and disposition of charges.


By submitting this application, you delcare all information listed on this application as true
to the best of your knowledge. You also agree that any falsification will result in immediate loss of
consideration for employment with George A. Mitchell Mfg Co. If hired and false information
is discovered after the fact, it will result in immediate termination. George A. Mitchell Mfg Co.
is an "At-Will" employer, which means at any time both the employer and the employee may
terminate their relationship, without notice or reason.

Send Application