Applicant Name* First Middle Last Alias/Maiden NameEmail Address Application LocationPlease choose a location...GeorgiaNorth CarolinaSouth CarolinaVirginiaPhone NumberDate of Birth MM DD YYYY Address Street Address City State / Province / Region ZIP / Postal Code Mailing AddressEmergency Phone NumberDate Available to Start Work MM DD YYYY Salary RequirementType of Employment DesiredchooseFull TimePart TimeTempAddress HisoryPlease list each address in which you resided during the past seven (7) years starting with the most recent. Street Address City State / Province / Region ZIP / Postal Code Street Address City State / Province / Region ZIP / Postal Code Street Address City State / Province / Region ZIP / Postal Code Street Address City State / Province / Region ZIP / Postal Code Education HistoryHigh SchoolYears AttendedDid You Graduate?YesNoAddressCollege/University NameYears AttendedMajor of StudyDid You Graduate?YesNoDegree EarnedAddressEmployment HistoryList your most recent job first.Company 1Company NameAddressJob TitleStart Date MM DD YYYY End Date MM DD YYYY Are You Eligible for Re-hire?YesNoEnding SalaryContact PersonCompany PhoneCompany 2Company NameAddressJob TitleStart Date MM DD YYYY End Date MM DD YYYY Are You Eligible for Re-hire?YesNoEnding SalaryContact PersonCompany PhoneCompany 3Company NameAddressJob TitleStart Date MM DD YYYY End Date MM DD YYYY Are You Eligible for Re-hire?YesNoEnding SalaryContact PersonCompany PhoneCompany 4Company NameAddressJob TitleStart Date MM DD YYYY End Date MM DD YYYY Are You Eligible for Re-hire?YesNoEnding SalaryContact PersonCompany PhoneTemporary Employment HistoryTemporary Employment 1Temporary AgencyCity and StateContact PersonStart Date MM DD YYYY End Date MM DD YYYY Temporary Employment 2Temporary AgencyCity and StateContact PersonStart Date MM DD YYYY End Date MM DD YYYY Temporary Employment 3Temporary AgencyCity and StateContact PersonStart Date MM DD YYYY End Date MM DD YYYY Technical and General SkillsCheck all that apply. A&P MECHANICA&P MECHANIC AUTO/TRUCK MAINTENANCE AERO PARTS ASSEMBLE PCB FROM BLUEPRINTS ASSEMBLE PCB FROM DIAGRAM ASSEMBLE PCB FROM SCHEMATICS ASSEMBLYAUTO PARTS BANQUET BANQUET SERVER BARTENDER BENCH DESIGN BINDERY BLUEPRINT WORK BOB CAT OPERATOR BODY SHOP MAINTENANCE BODY HOP PAINTER CALIPERS CARPENTRY CASHIER CDLA DRIVER CDLB DRIVER CNC OPERATOR CNC PROGRAMMING/SETUP COLLATOR COLOR CODE CONSTRUCTION, COMMERCIAL COMMERCIAL RESIDENTIAL CONSTRUCTION HELPER COOK CPR, CERTIFIED CRIMP & SOLDER CRT OPERATOR CUT FOAM/FIBER DELIVERY/VAN DIE CAST OPERATOR DISHWASHER DOT REG CERTIFIED DRAFTING DRILLPRESS DRYWALL INSTALL ELECTRICAL MAINTENANCE ELECTRICIAN CERTIFIED ELECTRICIAN HELPER ENGINEER, AERONAUTICAL ENGINEER, CIVIL ENGINEER, ELECTRICAL ENGINEER, INDUSTRIAL ENGINEER, MECHANICAL FINAL ASSEMBLY FINISHING ROOM FOOD SERVICE FOOD SERVER FOREMAN FORKLIFTCERTIFIED FORKLIFT, BOOM LIFT FORKLIFT, CHERRY PICKER LIFT FORKLIFT, STAND UP LIFT FORKLIFT, REACH LIFT FREIGHT FURNITURE MOVING FURNITURE INSTALL GUILLOTINE OUT GRINDERS-CNC GRINDERS-SURFACE HOSIERY HVAC IMPORT/EXPORT INSPECTOR/QUALITY ASSUR INTERIOR INSTALL INVENTORY JANITORIAL/HOUSEKEEPING KNOCK-UP LATHE,CNC LATHE, ENGINE LATHE OPERATOR LAWN/LANDSCAPE LOADING/UNLOADING LOOM FIXER MACHINE OPERATOR MAIL ORDER MAILROOM MAINTENANCE,BUILDING MAINTENANCE, GROUND MAINTENANCE, INDUSTRIAL MAINTENANCE, MACHINE MANUAL MACHINE SETUP MAINTENANCE, RESIDENTIAL MANUFACTURING METAL STAMPING MESSENGER MICROMETERS MILLING-CNC MILLING MACHINE MILLING-MANUAL ORDER PULLER PACKING PAINTING PICKING INVENTORY PLUMBING POWER TOOLS PRESS BRAKE-AUTO BACK PRESS BRAKE-CNC PRESS BRAK-MANUAL PRICING/TICKETING PRINTING PRESS PRODUCTION PROFESSIONAL MOVING PRODUCTION LINE PUNCH PRESS-CNC PUNCH PRESS-MANUAL QUALITY CONTROL ROBOTICS REPAIR SANDER, HAND SANDER, JITTERBUG SAW OPERATOR SEWING MACHINE OPERATOR SHEER-AUTO BACK GUAGE SHEER-MANUAL SHEET METAL SHIPPING/RECEIVING SHIPPING CLERK SLITTER OPERATOR SOLDERING SORTER/SORTING SPRAYER SPRING-UP STOCKER SUB ASSEMBLY SURVEYS SWATCHER SWITCHER TECHNICAL TEXTILES TOOL AND DIE TOUCH-UP TRIM PRESS TURRET PRESS-CNC UPHOLSTERY UPS MACHINE WAREHOUSE WAREHOUSE MANAGER WEAVING WELDING-ALUM WELDING-MIG WELDING-STIK WELDING-SPOT WELDING-TIG General Clerical SkillsCheck all that apply. 10 KEY DATA ENTRY ALPHA DATA ENTRY NUMERIC FILING SWITCHBOARD # OF LINES UPS/RPS SHIPPING Accounting SkillsCheck all that apply. ACCOUNTS PAYABLE BANK RECONCILIATION BOOKKEEPING COLLECTIONS/CREDIT COST ANALYSIS FINANCIAL STATEMENTS GENERAL LEDGER RECON INVOICING PAYROLL PEACHTREE PURCHASING QUICKBOOKS TAXES, PAYROLL WORKERS COMP INSURANCE Computer SkillsCheck all that apply. ACCESS AS400 IMPORT/EXPORT LOTUS 123/PROFESSIONAL MOVING MACINTOSH MICROSOFT EXCEL MICROSOFT OUK MICROSOFT PUBLISHER MICROSOFT WORD PAGEMAKER GRAPHICS SOFTWARE PEOPLE SOFT PHOTOSHOP POWERPOINT QUARK EXPRESS GRAPHICS SAT TIMBERLINE WEB DESIGN Medical SkillsCheck all that apply. ASSISTED LIVING CERTIFIED NURSES ASST CLAIMS PROCESSOR CLINICIAN CERTIFIED MEDICAL ASST CERT OPHTHAMOLOGY ASST CERT OPHTHAMOL. MED ASST CPR CERTIFIED CPT CODING CPT 800 CODING CPT 900 CODING CPT PHOENIX DENTAL OFFICE EKG MACHINE EMERGENCY MEDICAL TECH HYGIENIST ICD9 CODING INSURANCE PROCESSOR LICENSED PRACTICAL NURSE LONG TERM CARE MEDICAL BILLING MEDICAL FRONT OFFICE MEDICARE/MEDICAID MEDREC MEDRECORDS PHARM PHLEB RN PRIVATEDUT SCHED SCRIB VITAL XRAY IT SKillsCheck all that apply. A + CERTIFIED COMPUTER MAINTENANCE INFORMATION TECHNOLOGY NETWORK REPAIR PHONE REPAIR Additional SkillsCheck all that apply. ADMINISTRATIVE ASSISTANT BANK TELLER BI-LINGUEL CASHIER COLD CALLS/SALES CUSTOMER SERVICE REP DISPATCHER EXECUTIVE SECRETARY FRENCH HUMAN RESOURCES INSIDE SALES INSURANCE CLAIMS LEGAL SECRETARY MAILROOM PARALEGAL PERSONNEL RECRUITING RECEPTIONIST SPANISH TELEMARKETING TELLER PreferencesI do/do not wish to be considered for position that require me to (check yes or no):Stand for long period of time.YesNoWalk for long distance or periods of time.YesNoSit for long periods of time.YesNoLift/push/pull and/or carry 10lbs or less occasionallyYesNoLift/push/pull and/or carry 10lbs or less consistentlyYesNoLift/push/pull and/or carry 20lbs or less occasionallyYesNoLift/push/pull and/or carry 20lbs or less consistentlyYesNoLift/push/pull and/or carry 50lbs or less occasionallyYesNoLift/push/pull and/or carry 50lbs or less consistentlyYesNoLift/push/pull and/or carry 75lbs or less occasionallyYesNoLift/push/pull and/or carry 50lbs or less consistentlyYesNoClimb laddersYesNoStoop, kneel, crouch or crawl repetitivelyYesNoWork reaching overheadYesNoPerform somewhat repetitive actions, such as assembly workYesNoPerform highly repetitive work, such as packing or sewingYesNoPerform detail work with small parts, such as micro-circuitry.YesNoWork in outdoor conditionsYesNoWork indoors in cold conditionsYesNoWork around fumes, odors, dust and mistYesNoWear safety glassesYesNoWear earplugsYesNoWear respiratorYesNoCriminal Background InformationHave you ever been convicted of or pleaded guilty or nolo contendre to a crime or other offense? Include any and all court convictions, military service convictions, deferred adjudication or guilty or nolo contendre please.YesNoInclude any and all court convictions, military service convictions, deferred adjudication or guilty or nolo contendre pleas. If yes, please provide the date, place and offense of the charge:Are you currently on parole, probation, work release program, deferred adjudication, conditional release, or serving a weekend sentence as a result of a conviction or a guilty or nolo contendre plea?YesNoHave you ever been confined (incarcerated) as a result of the sentence of any court? (Include incarcerations resulting from the sentence of a military court or similar proceeding.)YesNoIf yes, please state where, when and the nature of the charge:Are you presently under indictment or are you currently a defendant in any criminal proceeding?YesNoIf yes, please provide the date and place of the occurrence to the indictment or pending charge, and the charge:Upload Cover Letter and ResumeCover Letter Titlepdf or doc formats onlyResume Titlepdf or doc formats onlyEmailThis field is for validation purposes and should be left unchanged.
