Employment Form Name* First Middle Last Phone Number*Email Address* Current Mailing Address* Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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?*YesNoAre you familiar with MIS by Accu-Tech ERP software?*YesNoDate available for work* Date Format: MM slash DD slash YYYY Desired Salary / Hourly Pay*Are you a citizen of the United States?*YesNoAre you authorized to work in the US?*YesNoAuthorization Start Date* Date Format: MM slash DD slash YYYY Were you previously employed at our company?*YesNoDate Employed From:Date Employed To:Have you ever been convicted of a felony?*YesNoCriminal 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 SchoolCity & StateDegree/Diploma Major Course of StudyHigh School Degree ReceivedYesNo GED EducationGEDCity & StateDegree/Diploma Major Course of StudyGED Degree ReceivedYesNo College EducationCollegeCity & StateDegree/Diploma Major Course of StudyCollege Degree Received?YesNo Graduate School EducationGraduate SchoolCity & StateDegree/Diploma Major Course of StudyGraduate School Degree ReceivedYesNo Trade School EducationTrade SchoolCity & StateDegree/Diploma Major Course of StudyTrade School Degree ReceivedYesNoEmployment HistoryPlease list all work experience beginning with the present or most recent job. Employment History 1Name of EmployerType of BusinessTitlePhone #Name of SupervisorTitle of SupervisorMay we contact?YesNoType of EmploymentFull-TimePart-TimeDate of Employment From:Date of Employment To:Last SalaryReason for Leaving Employment History 2Name of EmployerType of BusinessTitlePhone #Name of SupervisorTitle of SupervisorMay we contact?YesNoType of EmploymentFull-TimePart-TimeDate of Employment From:Date of Employment To:Last SalaryReason for Leaving Employment History 3Name of EmployerType of BusinessTitlePhone #Name of SupervisorTitle of SupervisorMay we contact?YesNoType of EmploymentFull-TimePart-TimeDate of Employment From:Date of Employment To:Last SalaryReason for LeavingBusiness ReferencesPlease list three individuals, in addition to listed employment references, known to you for at least three yearsReference 1 NameReference 1 OccupationReference 1 Phone #Reference 2 NameReference 2 OccupationReference 2 Phone #Reference 3 NameReference 3 OccupationReference 3 Phone #Military ServiceHave you ever served in the military?YesNoBranchDate Served From:Date Served To:Rank at dischargeType of dischargeIf 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)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* Date Format: MM slash DD slash YYYY eSignature**Please note: By entering your name in the below field, you are legally signing this document.