Apply – S and Y Industries

Name*

First Last

Date*

Referred By

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Date Available*

Desired Salary

Position Applied For*

Are you a Citizen of the United States?*

If no, are you authorized to work in the U.S.?*

Have you ever worked for this company?*

If so, When?

Have you ever been convicted of a felony?*

If so, Explain

Have you ever had experience with soldering or electronic assembly?*

If so, Explain

Education

High School

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From

To

Did you graduate?

Degree

College

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From

To

Did you graduate?

Degree

College

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From

To

Did you graduate?

Degree

References

Please list three professional references

Name

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

Relationship

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Employment

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Job Tittle

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for leaving

May we contact your previous supervisor for a reference?

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for leaving

May we contact your previous supervisor for a reference?

Company

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for leaving

May we contact your previous supervisor for a reference?

Availability

Days

List the days you would be able to work. (Example: Monday-Friday)

Hours

From-To

How many hours can you work weekly?

Can you work nights?

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that, if employed, my employment is to be “at will” and that either the company or I may terminate my employment at any time, with or without cause.

Signature

Date

Resume