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LaX Fabricating LTD |
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700 East Main Street, Spring Grove, MN 55974 |
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P.O. Box 891, La Crosse, WI 54602 |
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608-498-0536 |
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Middle |
Date |
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State |
Zip |
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Referred
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| Employment Desired |
| Position Desired |
Date
You Can Start |
Salary
Desired |
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| Are You Employed? Yes
No |
If So, May We Inquire of Your
Present Employment?
Yes No |
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| Ever Applied to This Company Before?
Yes No |
When? |
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______ / ______ / __________ |
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| Education History |
| Name & Location of School |
Years Attended |
Did You Graduate? |
Subjects Studied |
| High School |
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| Trade or Technical School |
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| General Information Other Study/Research Work, Special Training or Skills Not Outlined Above |
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| Former Employers (List Below Your Last Three Employers, Starting with the Most Recent) |
| Dates Month & Year |
Name & Address of Employer |
Salary/ Hourly |
Position/Job Description/Duties |
Reason For Leaving |
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| Skills Check-List (Mark an X next to all the skills you have been trained in or are proficient in doing.) |
| ______ |
Reading a tape measure |
Certifications |
Computer Skills |
| ______ |
Reading blueprints |
______ |
Mild steel welding |
______ |
Word Processing |
| Machine
Operations |
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Stainless steel welding |
______ |
Microsoft Word |
| ______ |
Saw operator |
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Aluminum welding |
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Microsoft Excel |
| ______ |
Iron worker operations |
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Stick welding |
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Microsoft Outlook |
| ______ |
Grinder |
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Mig welding |
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Workers' Comp. |
| ______ |
Pipe bending &/or Coping |
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Tig welding |
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Auto CAD |
| ______ |
Drill press |
______ |
Fork Lift Certification |
______ |
Web page design |
| ______ |
Spray painting |
______ |
Current First Aid Certification |
______ |
Copying/Faxing/Filing |
| ______ |
Fork lift |
______ |
Current CPR Certification |
Other |
__________________ |
| Other |
_______________________ |
Other |
_______________________ |
Other |
__________________ |
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| References (Give
below the names of three persons, not related, whom you have known at least one year.) |
| Name |
Address |
Title |
Phone
Number |
Years
Known |
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| Do you have pending criminal charges or have you ever pleaded guilty to
or been convicted of a felony? Yes No |
| If yes, supply additional information regarding the offense(s) including date. If the job you are applying for requires the |
| operation of a motor vehicle, include traffic convictions. __________________________________________________ |
| ____________________________________________________________________________________________ |
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| Authorization |
| "I
certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that,
if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers 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 the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of this company has any authority to enter into any
agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is
in writing and signed by an authorized company representative. This waiver does
not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities
Act (ADA) and other relevant federal and state laws." |
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| Date ___________________ Signature ___________________________________________________________ |
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| __________________________ DO NOT WRITE BELOW THIS LINE ____________________________ |
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| Remarks |
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| Interviewed By _____________________________________________ Date ______________________________ |
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| Neatness |
Character |
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| Personality |
Ability |
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| Hired |
Department |
Position |
Starting
Date |
Salary
Wages |
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| Approved:
1. ____________________________ |
2. _____________________ |
3. ________________________ |
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Employment Manager |
Department Head |
General Manager |
