Employment Application

First Name (required)

Last Name (required)

Street Address (required)

City (required)

State (required)

ZIP (required)

Birthdate DD/MM (required)

Phone (required)

Your Email

If you are under 18 (and it is required), could you get a Work Permit?
YesNoI'm 18 or older

Have you submitted an application here before?
YesNo

Have you ever been employed with Powder Cote II, Inc.?
YesNo

Are you legally eligible for employment in this country?
YesNo

When are you available to start? (DD/MM)

What shift/days are you available to work?
DaysAfternoonsEither Shift

Have you been convicted of a crime in the last 7 years?
(A conviction will not necessarily be a bar to employment.)
YesNo

If you answered Yes to the previous question, please explain:
(Each instance and explanation will be considered in relation to the position for which you are applying.)

Do you have reliable transportation?
YesNo

Position Applying For:

Referred By:
Current/Past EmployeeAdvertisementWalk-InNone

Referrer Name

Employer

Phone Number

Street Address

City

State

ZIP

Date Employment Began

Date Employment Ended

Reason Employment Ended:
(leave blank if you are still employed by this employer)

Hourly Wage

Supervisor Name

Job Description

May we contact this employer for a reference?
YesNo

Employer

Phone Number

Street Address

City

State

ZIP

Date Employment Began

Date Employment Ended

Reason Employment Ended:
(leave blank if you are still employed by this employer)

Hourly Wage

Supervisor Name

Job Description

May we contact this employer for a reference?
YesNo

Employer

Phone Number

Street Address

City

State

ZIP

Date Employment Began

Date Employment Ended

Reason Employment Ended:
(leave blank if you are still employed by this employer)

Hourly Wage

Supervisor Name

Job Description

May we contact this employer for a reference?
YesNo

School Name & Location

Years Attended

Degree Earned
GEDHigh School DiplomaAssociates DegreeBachelors DegreeMasters DegreeDoctoral DegreeHave not graduated / currently attendingDid not graduate