Position(s) Applied for:

Date of Application:

How did you learn about us?

Pay Expected:

Last Name: First Name: Middle Initial:

Address:

City: State: Zip:

Telephone Number:

Social Security Number:

If you are under 18 years of age, can you provide proof of your eligibility to work? YES NO

Have you ever filed an application with us before? YES (If yes, give date) NO

Have you ever been employed with us before? YES (If yes, give date) NO

Are you currently employed? YES NO

May we contact your present employer? YES NO

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? YES NO
(proof of citizenship or immigration status will be required upon employment)

On what date would you be available for work?

Are you available to work: Full Time: Part Time: Shift Work: Temporary:

Are you currently on "lay off" status and subject to recall? YES NO

Can you travel if a job requires it? YES NO

Have you been convicted of a felony within the last seven years? YES NO
(Conviction will not necessarily disqualify an applicant from employment)

If yes, please explain:

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

EDUCATION

High School:
Name and Address of School:

Undergraduate College:

Name and Address of School:

Course of Study:

Years Completed:

Diploma Degree:

Graduate Professional:

Name and Address of School:

Course of Study:

Years Completed:

Diploma Degree:

Other: (Specify)

Name and Address of School:

Course of Study:

Years Completed:

Diploma Degree:

Indicate any Foreign Languages You Can Speak, Read, and/or Write:

Speak:
Fluent: Good: Fair:

Read:
Fluent: Good: Fair:

Write:
Fluent: Good: Fair:

Describe any specialized training, apprenticeship, skills and extra-curricular activities:

Describe any job-related training received in the United States Military:

EMPLOYMENT EXPERIENCE: (please begin with most recent job)

1.

Employer:

Address:

Telephone Number(s):

Reason for Leaving :

Job Title:

Time of Employment:

Work Performed:

Hourly Rate From :

Salary To:

Supervisor:

2.

Employer:

Address:

Telephone Number(s):

Reason for Leaving :

Job Title:

Time of Employment:

Work Performed:

Hourly Rate From :

Salary To:

Supervisor:

3.

Employer:

Address:

Telephone Number(s):

Reason for Leaving :

Job Title:

Time of Employment:

Work Performed:

Hourly Rate From :

Salary To:

Supervisor:

4.

Employer:

Address:

Telephone Number(s):

Reason for Leaving :

Job Title:

Time of Employment:

Work Performed:

Hourly Rate From :

Salary To:

Supervisor:

ADDITIONAL INFORMATION:

Other Qualifications:
Summarize special job-related skills and qualifications acquired from employment or other experience:

Specialized Skills:

PLC PC Excel Microsoft Word Access Multi-line Phone
Spread Sheets AutoCad 2000 AS 400 Domino Lotus

Production/Mobile Machinery (list):

Other (list):

State any additional information you feel may be helpful to us in considering your application:

References:
List individuals (other than former employers and relatives) who have known you at least two years and whom we may contact:

Name and Occupation:

Address:

Telephone Number:

Name and Occupation:

Address:

Telephone Number:

Name and Occupation:

Address:

Telephone Number:

BEFORE SUBMITTING APPLICATION PLEASE READ THE FOLLOWING

1. The information provided by me in this employment application is true and complete. If I am hired, the discovery of false information provided or relevant information omitted - no matter when discovered - may result in the termination of my employment.

2. I authorize Joseph Machine Company, Inc. to make whatever inquires it considers necessary of any person or organization which is not a consumer reporting agency to verify any information provided in this application to determine any job-related qualifications and abilities.

3. In exchange for Joseph Machine Company's agreement to receive, process and consider my application for employment, I release Joseph Machine Company, Inc. and all persons, schools and organizations contacted by Joseph Machine Company, Inc. from all claims or causes of action arising out of joseph Machine Company's verification of the information provided in this application and/or its determination of my job-related qualifications and abilities.

4. My application will apply only to currently available openings, and I must file other applications in the future to the extent that I seek employment in the future from Joseph Machine Company, Inc.

5. If Joseph Machine Company, Inc. offers me employment, it may be contingent upon completion of a medical examination to the satisfaction of the Company. I consent to undergo that medical examination, which will include tests and procedures considered by the Company helpful in evaluating my suitability for employment, including, without limitation, urinalysis and drug screening.

6. Except as otherwise provided by a signed agreement covering my employment, if hired, my employment at Joseph Machine Company, Inc. is "at will" and would continue for only as long as I or the Company wish it to continue. Either I or the Company may terminate my employment at any time for any or no reason except as otherwise provided by law or signed agreement. To be effective, any modification of the "at will" arrangement must be in writing and signed by me and an authorized representative of Joseph Machine Company, Inc.

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