Employment Application Employment Application *Required Position(s) Applied For*: Core MakerMolderGrinderMaintenance TechnicianFlexible Date of Application*: First Name*: Middle Name: Last Name*: Street Address*: City*: State*: PennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code*: Telephone Number*: Email Address*: Are you legally eligible to work in the United States? ---yesno Are you over the age of 18 years? ---yesno Can you, with or without reasonable accommodation, perform the essential functions of this job? ---yesno Have you ever applied to West Salisbury Foundry and Machine Company before? ---noyes If so, please give date: Have you ever worked for West Salisbury Foundry and Machine Company before? ---noyes If so, please give date: Have you ever been convicted of a felony? ---noyes If yes, please explain: Do you have a valid driver’s license? ---yesno Have you ever been convicted of any moving violations in the past five years? ---noyes If yes, please explain: Is anyone related to you employed by West Salisbury Foundry and Machine Company? ---noyes If yes, please give name and relationship: What salary or rate of pay do you expect to receive if employed?* Have you ever been terminated or asked to resign from a job? ---noyes If yes, please explain: On what date would you be available to work?* Please list your days and hours available to work: Education: Please list school name and location, course of study/major, years completed, diploma/degree: Elementary School: High School: College: Graduate: Vocational: Please list any academic honors, scholarships, offices held, etc.: Describe any specialized training, apprentices, licenses, or skills: Have you received any job-related training in the United States Military? ---yesno If yes, please give dates and explain: Employment History: Begin with your current or most recent employer: Company Name: Employment Start Date: Employment End Date: Salary/Rate of Pay: Phone Number: Location: Name and Title of Supervisor: Reason for Leaving and Explanation: Describe your Duties: Company Name: Employment Start Date: Employment End Date: Salary/Rate of Pay: Phone Number: Location: Name and Title of Supervisor: Reason for Leaving and Explanation: Describe your Duties: Company Name: Employment Start Date: Employment End Date: Salary/Rate of Pay: Phone Number: Location: Name and Title of Supervisor: Reason for Leaving and Explanation: Describe your Duties: Company Name: Employment Start Date: Employment End Date: Salary/Rate of Pay: Phone Number: Location: Name and Title of Supervisor: Reason for Leaving and Explanation: Describe your Duties: Please provide any other information that you feel will help us in considering your application for employment: References Please list three people who are not related to you or are previous supervisors, who can provide professional reference. References may not include family members or previous WSF supervisors. Name: Phone: Address: City: State: Select OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Years Known: Relationship/Occupation: Name: Phone: Address: City: State: PennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Years Known: Relationship/Occupation: Name: Phone: Address: City: State: PennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Years Known: Relationship/Occupation: