Shift Desired

Days - 6:00 am - 2:30 pm Monday thru Friday

First Name Middle Name Last Name

Street Address City State AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code

Telephone Cell Phone Social Security Number

eMail Address

Are you under the age of 18? Yes No

Are you legally eligible for employment in the United States? Yes No

Have you been convicted of a felony within the last 7 years? Yes No

If yes, please explain

How did you learn about Midwest Railcar Repair, Inc.?

Radio
Walk-In
Newspaper
Friend/Relative
Employment Agency

Have you ever been employed with us before? Yes No

If yes, please give dates you worked here

Are you capable of satisfactorily performing the essential job duties of the position for which you are applying, with or without reasonable accommodation? Yes No

Do you have a valid drivers license? Yes No

Drivers License Number State of Issue AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Expiration Date

Operator
Commercial (CDL)

Can you travel if a job requires it? Yes No

Education

Name of School
Type of School High School College/Technical School
Address of School Diploma Degree

 

Name of School
Type of School High School College/Technical School
Address of School Diploma Degree

GED

References
(Please list two references other than relatives or previous employers)

Name Phone Number
Address Relationship


Name Phone Number
Address Relationship

Work Experience
(Please list your previous work experience beginning with your most recent job held. Include explanation for any gaps in employment. If you were self-employed, give firm name)

Name of Employer Address City
State AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Phone Number Your Last Job Title
Last Supervisor Employment Dates : To From

Reason For Leaving (be specific)


List duties performed, skills used or learned, advancements or promotions while you worked at this company.


May we contact your present employer? Yes No

 

Name of Employer Address City
State AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Phone Number Your Last Job Title
Last Supervisor Employment Dates : To From

Reason For Leaving (be specific)


List duties performed, skills used or learned, advancements or promotions while you worked at this company.

Name of Employer Address City
State AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Phone Number Your Last Job Title
Last Supervisor Employment Dates : To From

Reason For Leaving (be specific)


List duties performed, skills used or learned, advancements or promotions while you worked at this company.

Application for Employment Questionnaire
Please Check The Appropriate Skill Level and Answer the Questions to the Best of Your Knowledge

Applicant's Statement

PLEASE READ THE FOLLOWING

I certify that answers given in this application are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application or in any interview is sufficient cause for refusal to hire, or dismissal if I have been employed. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at any employment decision.

This application for employment shall be considered active for 90 days. Any applicant not hired during this time period must complete a new application to be considered for employment.

I understand that my employment is contingent upon passing a post-offer pre-employment screen for illegal drug usage.

I further understand that if I am hired, my employment will be "At-Will" and without fixed term, and may be terminated at any time, with or without prior notice, at the option of either myself or the Company.

I understand the contents of this applicant's statement and hereby acknowledge receipt of this information.

I agree that by checking this box that all of the answers and statements are true and correct within my application and that it serves as my electronic signature.

Type your full name I agree