Sivyer Steel Corporation - A Meterra Company

PERSONAL INFORMATION:

Date: / /

Last Name:

First Name:

Middle Name:

Address:

Phone: ( )- -

City:

State:

Zip: -

Position Applied For:

Social Security Number:
- -

Which Shifts are you willing to work:
1st 2nd 3rd

How were you referred to this company:
Employee
Advertisement
Own Initiative
State Employment Service
Other

Have you ever been employed by this company?
Yes No
If yes, when and where:

EDUCATION:

Name of School	Location	Graduated	Degree/Major

MILITARY:

Branch of Service:

Dates of Active Duty:

From:

To:

Highest Rank Held:

List any special training received:

SKILLS:

Specialized technical and clerical skills:
(i.e. Equipment Operation, Special Tools or Machines Used, Computer Languages,Typing, Shorthand,
Keypunch, etc.)

BACKGROUND INFORMATION:

Are you a U.S. Citizen? Yes No

If not, what is your current immigration status?

Have you ever been convicted of a felony? Yes No

If yes, give details:

PERSONAL PREFERENCES:

Name	Address/Phone	Occupation

EMPLOYMENT HISTORY: (List in Order with Last or Current Employer First)

Name of Company and Address:

From: To:

Nature of Business:

Supervisor Name and Title:

Title and Description of Responsibilities:

Reason for Leaving or Considering Change:

Monthly Salary or Hourly Rate:
Start Rate: End Rate:

2

Name of Company and Address:

From: To:

Nature of Business:

Supervisor Name and Title:

Title and Description of Responsibilities:

Reason for Leaving or Considering Change:

Monthly Salary or Hourly Rate:
Start Rate: End Rate:

3

Name of Company and Address:

From: To:

Nature of Business:

Supervisor Name and Title:

Title and Description of Responsibilities:

Reason for Leaving or Considering Change:

Monthly Salary or Hourly Rate:
Start Rate: End Rate:

4

Name of Company and Address:

From: To:

Nature of Business:

Supervisor Name and Title:

Title and Description of Responsibilities:

Reason for Leaving or Considering Change:

Monthly Salary or Hourly Rate:
Start Rate: End Rate:

I hereby authorize the company to investigate all statements contained in this application and I authorize the release of such factual information without liability for any damages whatsoever to the giver or receiver thereof. I understand that misrepresentation or omission of facts called for in this application is cause for disciplinary action up to and including dismissal. I further agree to submit to a pre-employment physical exam, and in the event I am employed, to abide by all company policies and regulations, including periodic physical exams thereafter.

Name:
E-mail: