Employment Application

Personal

Full Name (First + Middle + Last)*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Email*

Are you authorized to work lawfully in the U.S? (In compliance with federal law, all persons hired will be required to verify eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.)*

Yes
No

Are you at least 18 years or older? (If no, you may be required to provide authorization to work and/or may not be eligible for certain hazardous occupations pursuant to federal and state laws)*

Yes
No

Employment Desired

Which Position(s) are you applying for?

Hourly Rate/Salary Desired*

Date You Can Start*

Are you able to work: (check all that apply)*

If you cannot work full time, please explain:

If necessary for the job are you able to fulfill the required hours of the position?*

Yes
No

If necessary for the job are you able to provide a valid Driver’s License?*

Yes
No

Referral Source

How did you hear about us?

Walk In
Referral
Advertisement
Other

Referral, Advertisement, or Other - Please Specify:

Do you have any relatives or friends who work for our company?*

Yes
No

Names of friends or relatives employed in this organization

Employment History

Have you ever been employed by this organization before?*

Yes
No

If yes, list job title, dates, and location of employment*

Are you currently employed?*

Yes
No

May we contact your most recent employer?*

Yes
No

If yes, why are you considering leaving?*

Have you ever been discharged or asked to resign from a job?*

Yes
No

If yes, please explain.*

Employment History Details

Please provide your last ten (10) years of employment history, including periods of unemployment and U.S. Military Service. Start with your most recent employer and work backwards in time.

Company Name (Most Recent)

Address

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

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Did you have another job before this one?*

Yes
No

Company Name (Second Most Recent)

Address

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

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Would you like to list another previous job?

Yes
No

Company Name (Third Most Recent)

Address

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

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Would you like to list a 4th job?

Yes
No

Company Name (Fourth Most Recent)

Address

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

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Education

List your education history starting with highschool

Name	Number of Years	Subjects Studied/Major	Graduate or Degree

List any business or job related academic honors, achievements, extracurricular activities, or memberships in business or job related organizations.

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for?

Computer Skills (please describe)

Professional License and Membership

Type of License(s) Held

Other Professional Memberships (You may omit any that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status)

References

List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)

Name	Phone	Company	Job Title	Type of Relationship

Resume Upload (optional)

If you have a resume you'd like to attach, please do so here. This is not required.

Would you like to add a cover letter?

Yes
No

Cover Letter (optional)

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.

Acknowledgement

Phoenix Manufacturing, LLC is an equal opportunity employer. Phoenix Manufacturing, LLC does not discriminate in employment based on race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service or any other basis protected by federal, state, or local law. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Phoenix Manufacturing, LLC to hire me. If I am hired, my employment will be considered, “at-will”, which means that either Phoenix Manufacturing, LLC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Phoenix Manufacturing, LLC has the authority to make any assurance to the contrary. I attest with my signature below that I have given to Phoenix Manufacturing, LLC true and complete information on this application and in the interviewing process. No requested information has been concealed. I authorize Phoenix Manufacturing, LLC to contact references provided for employment reference checks. I hereby release Phoenix Manufacturing, LLC from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. If any information I have provided is untrue, or if I have concealed or omitted information, I understand that this will constitute cause for the denial of employment or immediate dismissal from employment if I am hired.

Digital Signature:

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date

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