Form - West Salisbury Foundry

Position(s) Applied For:
Core MakerMolderGrinderMaintenance TechnicianFlexible

Date of Application:
First Name:

Middle Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Telephone Number:

Email Address:

Are you legally eligible to work in the United States?

Are you over the age of 18 years?

Can you, with or without reasonable accommodation, perform the essential functions of this job?

Have you ever applied to West Salisbury Foundry and Machine Company before?

If so, please give date:

Have you ever worked for West Salisbury Foundry and Machine Company before?

If so, please give date:

Have you ever been convicted of a felony?

If yes, please explain:

Do you have a valid driver’s license?

Have you ever been convicted of any moving violations in the past five years?

If yes, please explain:

Is anyone related to you employed by West Salisbury Foundry and Machine Company?

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?

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?

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 2:

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 2:

Employment Start Date:
Employment End Date:
Salary/Rate of Pay:
Phone Number:
Location:
Name and Title of Supervisor:

Company Name 3:

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.

Name:
Phone:
Address:
City:
State:

Zip Code:
Years Known:
Relationship/Occupation:

Name:
Phone:
Address:
City:
State:

Zip Code:
Years Known:
Relationship/Occupation:

Name:
Phone:
Address:
City:
State:
Years Known:
Relationship/Occupation: