Job Application: Assembly Line Worker This entry was posted on October 28, 2015 by tcrawley1911. Programs, services and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.Title: Assembly Line WorkerFields marked with an asterisk (*) must be filled out before submitting.Applicant DataLast Name *First Name *Middle NameAddress *City *State *ZIP *Phone *Cell/Other PhoneE-mail *Date Available To Start * Social Security No. *Salary Requirement *If you are under 18 and we require a work permit, can you furnish one? Yes NoIf no, please explain Have you worked for this company? * Yes NoIf yes, when? Are you a citizen of the United States? * Yes NoIf not, are you legally allowed to work in the United States? Yes NoType of employment desired * Full-time Part Time Temporary SeasonalHave you ever pled guilty, no contest or been convicted of a crime? * Yes NoIf yes, give dates and details Answering “yes” to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of violation, rehabilitation and position applied for will be considered.Drivers license number if applicable to positionStateWho referred you to us?EducationHigh School *Address *Number of Years Completed *GPA *Did you graduate? * Yes NoCollege/UniversityAddressNumber of Years CompletedGPADid you graduate? Yes NoOtherAddressNumber of Years CompletedGPADid you graduate? Yes NoReferencesName *Phone *Address *City *State *ZIP *Name *Phone *Address *City *State *ZIP *Summarize Your Special Skills or QualificationsSummary Previous Employment (begin with most recent position)Employment Start Date Employment End Date Position(s) HeldFirmAddressPhoneSupervisorTitleResponsibilitiesStarting Salary and TitleEnding Salary and TitleReason for LeavingMay we contact this employer for a reference? Yes No * I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I hereby release employers, schools or persons from all liability when responding to inquiries in connection with my application. * In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.