S.L. Chasse Welding and Fabricating, Inc.
Application For Employment

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We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion or national origin.

Note: We may or may not be hiring at this time. Your application will be held on file in the event a position becomes available.

PERSONAL INFORMATION

NAME

First

Middle

Last

PRESENT ADDRESS

Street

Apt.

City

State

Zip

PERMANENT ADDRESS

Street

Apt.

City

State

Zip

PHONE NO.

REFERRED BY:

EMPLOYMENT DESIRED

Position

Date you can start
(mm/dd/yy)
     

Salary Desired

Are you employed now?

If so, may we inquire of your present employer?

Ever applied to this
company before?

When?
(mm/yy)
   

EDUCATION

HIGH SCHOOL

Name & Location of School

Did you
graduate?

Years
completed

Subjects Studied and Degree(s) Rec.

TRADE, BUSINESS OR MILITARY TRAINING

Name & Location of School

Did you
graduate?

Years
completed

Subjects Studied and Degree(s) Rec.

COLLEGE

Name & Location of School

Did you
graduate?

Years
completed

Subjects Studied and Degree(s) Rec.

GRADUATE SCHOOL

Name & Location of School

Did you
graduate?

Years
completed

Subjects Studied and Degree(s) Rec.

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK

CERTIFICATES/LICENSES YOU POSSESS

FORMER EMPLOYERS
List below last four employers, starting with last one first

From/
To
(mm/yy)
 /
 /

Employer’s Name & Address

Salary

Position

Reason For Leaving

 /
 /

 /
 /

 /
 /

REFERENCES
List three previous immediate supervisors

Name

Company

Address

Telephone

PHYSICAL RECORD
Do you have any physical condition which may limit your ability to perform the job applied for? 

If so, please explain

EMERGENCY NOTIFICATION CONTACT INFORMATION

Name

Address

Telephone

I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.

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