First Name
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Last Name
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Email
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Phone
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Address
City
State
Postal code
Previous Address if less than 5 years at the current address (City, State)
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Have you been terminated or asked to resign? If yes, provide details.
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Yes
No
Details (if yes)
Have you pled guilty or "no contest" to a crime, been convicted of a crime, had adjudication withheld or prosecution deferred? If yes, please give date and details. (Conviction record may not necessarily prohibit employment. Factors such as date, nature and offense will be considered)
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Have you been a defendant in a suit such as assault, battery, false imprisonment, wrongful death? If yes, please give date and details.
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Minimum pay rate $
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Position Applying For
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Date available to start
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How did you learn about our company and/or position? If employee referral, provide name:
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Are you willing to relocate within 35 miles of the Umpqua Sheet Metal office location?
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Yes
No
Are there days or hours you would be unable to work?
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Yes
No
If yes, when?
Will you be able to work overtime?
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Yes
No
Will you be able to travel within Oregon?
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Yes
No
Have you applied with our company before?
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Yes
No
If yes, when?
Have you been employed by Umpqua Sheet Metal?
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Yes
No
If yes, when?
Reason for Leaving?
High School Name
*
High School City/State
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Graduated?
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Yes
No
GED?
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Yes
No
College Name
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College City/State
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Years Completed
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Years Completed
0
1
2
3
4
No elements found. Consider changing the search query.
List is empty.
Graduate School Name
*
Graduate School City/State
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Graduate School Years Completed
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Graduate School Years Completed
0
1
2
3
4
No elements found. Consider changing the search query.
List is empty.
Are you planning on Continuing Education?
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Yes
No
If yes, when, where and what courses?
List any educational honors and activities involved in during school
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List and describe specialized training
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Professional License
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Certification
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Some positions require reporting to different job sites. Reliable transportation is necessary. Will you be able to report on a regular consistent basis? If no, explain
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Do you have a valid driver's license issued in Oregon?
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Yes
No
Any history of license restrictions? If yes, explain
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Reference 1 Name
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Reference 1 City
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Reference 1 Phone
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Reference 1 Occupation
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Reference 2 Name
Reference 2 City
Reference 2 Phone
Reference 2 Occupation
Reference 3 Name
Reference 3 City
Reference 3 Phone
Reference 3 Occupation
Employer 1
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Previous Position 1
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City, State 1
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Employer 1 Telephone
*
Employer 1 - Supervisor's Name
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Employer 1 Starting Salary
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Employer 1 Ending Salary
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Employer 1 Start Date (mo/yr)
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Employer 1 End Date (mo/yr)
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Employer 1 Duties
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Employer 1 - What did you like most about your job?
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Reason for leaving Employer 1
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Eligible for Re-hire with Employer 1?
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Yes
No
Employer 2
Previous Position 2
City, State 2
Employer 2 Telephone
Employer 2 - Supervisor's Name
Employer 2 Starting Salary
Employer 2 Ending Salary
Employer 2 Start Date (mo/yr)
Employer 2 End Date (mo/yr)
Employer 2 Duties
Employer 2 - What did you like most about your job?
Reason for leaving Employer 2
Eligible for Re-hire with Employer 2?
Yes
No
Employer 3
Previous Position 3
City, State 3
Employer 3 Telephone
Employer 3 - Supervisor's Name
Employer 3 Starting Salary
Employer 3 Ending Salary
Employer 3 Start Date (mo/yr)
Employer 3 End Date (mo/yr)
Employer 3 Duties
Employer 3 - What did you like least about your job?
Reason for leaving Employer 3
Eligible for Re-hire with Employer 3?
Yes
No
If you worked using another name, please list name(s) here. List previous name 1, and at which company
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List previous name 2, and at which company
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Are you currently employed?
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Yes
No
If yes, may we contact your present employer?
Yes
No
Have you been disciplined, warned, demoted, suspended, placed on probation or terminated? If yes, explain
*