Submitted by admin on Tue, 08/14/2018 - 15:48 Notice to Applicants and Employees Screening tests for alcohol and illegal drugs may be required before hiring and during your employment. Personal Name Age Street City State How long at this address? How long in this vicinity? Are you a citizen of the United States? Yes No If no, are you authorized to work in the United States? Yes No Have you ever been convicted of or pled guilty to a felony? Yes No Email Home Phone Best Time to Call Mobile Phone Best Time to Call Education High School Number of Years Completed Last Grade Completed College Number of Years Completed Last Grade Completed Other Number of Years Completed Last Grade Completed Employment From To Employer Phone City, State Job Title Duties Supervisor's Name Ending Salary / Wages Resason for Leaving Employment From To Employer Phone City, State Job Title Duties Supervisor's Name Ending Salary / Wages Resason for Leaving Employment From To Employer Phone City, State Job Title Duties Supervisor's Name Ending Salary / Wages Resason for Leaving Special Skills or Training Position(s) Desired Hours / Days Available U.S. Military Record Branch of Service From To Duties Discharge Date U.S. Military Record Branch of Service From To Duties Discharge Date References Name Address Years Known References Name Address Years Known References Name Address Years Known Additional Information Have you ever worked for Micro Metals? List names of relatives employed by Micro Metals Have you objections to running machinery? Referred by Applying for: Full Time Part Time Temporary Applicant's Statement I certify that statements made by me on this form are true and correct. I understand that if employed, any false statement on this application can be considered cause for dismissal. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at the an employment decision. Signature Date Month MonthJun Day Day3 Year Year2023
