Employment Form For Material Handling Positions

Position Applied for:

.NET Web Developer

PERSONAL DATA

* Required Information

Last Name *

First Name *

Middle Name

Address Number & Street *

City *

State *

Zipcode *

Daytime Phone *

Evening Phone

E-Mail: *

Are you:

18 or older? *

a previous employee? *

currently employed? *

legally eligible for employment in the United States of America? *

a licensed driver? *

License no.

State of Issue

How did you learn about the position? *
Check type of employment desired:
What is your shift availability?
Can you travel if the job requires?
Will you relocate if the job requires?
Have you been convicted of a felony or misdemeanor? *
(Conviction will not necessarily disqualify an applicant from employment) IF Yes, please explain

EMPLOYMENT RECORD (List most recent employer first)

* Required Information

Employer 1 *

From: *

To: *

Address *

Title *

Beginning Salary *

Ending Salary *

Responsibilities

Reason for leaving

[ more ]

Employer 2 From: To:

Address

Title Beginning Salary Ending Salary

Responsibilities

Reason for leaving

[ more ] [ hide ]

Employer 3 From: To:

Address

Title Beginning Salary Ending Salary

Responsibilities

Reason for leaving

[ more ] [ hide ]

Employer 4 From: To:

Address

Title Beginning Salary Ending Salary

Responsibilities

Reason for leaving

[ more ] [ hide ]

Employer 5 From: To:

Address

Title Beginning Salary Ending Salary

Responsibilities

Reason for leaving

[ hide ]

EDUCATION

* Required Information

Check the highest year completed: *

Type of Degree 1

Major

Minor

Name and Location *

Dates Attended: from

Graduated

Please list any scholastic honors, awards, subjects or special study, research, publications, patents and/or thesis:

[ more ]

Type of Degree 2 Major Minor

Name and Location

Dates Attended: from to Graduated

Please list any scholastic honors, awards, subjects or special study, research, publications, patents and/or thesis:

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Type of Degree 3 Major Minor

Name and Location

Dates Attended: from to Graduated

Please list any scholastic honors, awards, subjects or special study, research, publications, patents and/or thesis:

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ADDITIONAL SKILLS

Do you have personal computer skills?

If Yes, please describe the type of software and hardware that you are proficient in:

Please describe any other specialized training, apprenticeships and/or skills that you possess:

PROFESSIONAL ASSOCIATIONS

Please list any professional, trade, business or civic activities and offices held. You may exclude membership which would reveal race, color, religion, sex, gender, national origin, age, disability, marital, veteran status or any other legally protected status.

ADDITIONAL INFORMATION

Attach Resume:
Additional Comments:

NOTE TO APPLICANT

* Required Information

I feel that I can perform the job functions of the open position. *

Please read the following Statement
I understand and expressly agree that Mitsubishi Forklift America Inc. may make or employ an agency to make such pre-employment investigation of my competence, character, general reputation and personal characteristics as it deems necessary, and that information concerning such matters may be obtained through contacts or interview with former employers, friends, associate or other persons with whom I am acquainted or who may have knowledge concerning the attributes referred to. I expressly consent to such investigation and release all parties from liability for any damage that may result from furnishing same to you. I also understand that I have been informed that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of the nature and scope of the investigation made.
I understand that employment at MCFA Inc. is employment at will, where, if employed by MCFA Inc., I may sever my employment with MCFA Inc. for any or no reason and MCFA Inc. may terminate my services on the same basis. I understand and agree that at no time, if employed by MCFA Inc. will any MCFA Inc. information be revealed to anyone other than those authorized to receive it. I understand that the giving of proprietary MCFA Inc. information to those not authorized to receive such information is unlawful and shall be sufficient cause for my immediate dismissal.
In compliance with the Immigration Reform and Control Act of 1986 MCFA Inc. will only hire United States citizens and aliens who are authorized to work in the United States. To facilitate this objective each individual hired by MCFA Inc. must provide original documentation specified by the Immigration Act which verifies identity and employment eligibility.
I certify that all the information given on this form is true to the best of my knowledge and belief, and I understand that I will be subject to dismissal, if employed by MCFA Inc., if I have made any misrepresentation herein. I also give consent to any medical examination required by MCFA Inc. subsequent to a written offer of employment. I understand that a satisfactory completion of a medical examination is a condition of employment with MCFA Inc.

I understand that information on this employment application has been requested for purposes of evaluating my qualifications in regards to employment with MCFA Inc.

Applicants Signature *

Date *