Employment Form Name* First Middle Last Phone Number*Email Address* Current Mailing Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position for which you are applying: Accounting Clerical Driver Inside Sales MTR Department Outside Sales Warehouse Are you familiar with MetalTrace MTR software?* Yes No Are you familiar with MIS by Accu-Tech ERP software?* Yes No Date available for work* MM slash DD slash YYYY Desired Salary / Hourly Pay* Are you a citizen of the United States?* Yes No Are you authorized to work in the US?* Yes No Authorization Start Date* MM slash DD slash YYYY Were you previously employed at our company?* Yes No Date Employed From: Date Employed To: Have you ever been convicted of a felony?* Yes No Criminal Records*Please provide the date(s) and describe that criminal record so the individual circumstances can be considered.Education & TrainingPlease select all educational experience you possess: High School GED College Graduate School Trade School High School EducationHigh School City & State Degree/Diploma Major Course of Study High School Degree Received Yes No GED EducationGED City & State Degree/Diploma Major Course of Study GED Degree Received Yes No College EducationCollege City & State Degree/Diploma Major Course of Study College Degree Received? Yes No Graduate School EducationGraduate School City & State Degree/Diploma Major Course of Study Graduate School Degree Received Yes No Trade School EducationTrade School City & State Degree/Diploma Major Course of Study Trade School Degree Received Yes No Employment HistoryPlease list all work experience beginning with the present or most recent job. Employment History 1Name of Employer Type of Business Title Phone #Name of Supervisor Title of Supervisor May we contact? Yes No Type of Employment Full-Time Part-Time Date of Employment From: Date of Employment To: Last Salary Reason for Leaving Employment History 2Name of Employer Type of Business Title Phone #Name of Supervisor Title of Supervisor May we contact? Yes No Type of Employment Full-Time Part-Time Date of Employment From: Date of Employment To: Last Salary Reason for Leaving Employment History 3Name of Employer Type of Business Title Phone #Name of Supervisor Title of Supervisor May we contact? Yes No Type of Employment Full-Time Part-Time Date of Employment From: Date of Employment To: Last Salary Reason for Leaving Business ReferencesPlease list three individuals, in addition to listed employment references, known to you for at least three yearsReference 1 Name Reference 1 Occupation Reference 1 Phone #Reference 2 Name Reference 2 Occupation Reference 2 Phone #Reference 3 Name Reference 3 Occupation Reference 3 Phone #Military ServiceHave you ever served in the military? Yes No Branch Date Served From: Date Served To: Rank at discharge Type of discharge If other than honorable, please explain: ResumeIf you have a resume you would like to submit with your application form, you may upload it here.Resume Upload (optional)Max. file size: 50 MB.Consent, Date & SignPlease read the following statement carefully:*I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsification or significant omission of information requested in this application or in the application process may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I authorize all persons listed above (and on the accompanying resume, if any) to give employer and/or any service providers any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and employer and/or any service providers, from liability for any damage that may result from furnishing same to employer and/or any service providers. I understand and agree to the above statement.Date* MM slash DD slash YYYY eSignature**Please note: By entering your name in the below field, you are legally signing this document.