Contact Air Power Equipment for Service on Compressed Air Systems, Vacuum Systems, and Blasting Equipment

* denotes required fields

First Name:

* Middle: Last Name:

Social Security # :

Address:

City:

State:

Zip Code:

Phone:

Home: Work / Cell

Email:

Position(s) applied for :

Date of application:

Referral Source: (Please check the appropriate category and name the source):

Walk-in

School

Employee

Job Fair

Staffing Agency

Company's Website

Government Employment Agency

Other Internet

Other

If necessary, best time to call you at home is: AM PM

May we contact you at work? Yes No

Will you travel if job requires it? Yes No

If yes, work number and best time to call:

If they have been explained to you, are you able to meet the attendance requirement of the position? Yes No N/A

Phone:
Time: AM PM

Will you work overtime if required?Yes No if no, please explain:

If you are under 18 and it is required, can you furnish a work permit? Yes No

Driver's license number required if driving may be required in the job for which you are applying:
State

If no, please explain :

Have you ever been bonded? Yes No

Answering "yes" to the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

Have you submitted an application here before? Yes No

If yes, give date(s) and position(s)

Date: Position

Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?
Yes No

Have you ever been employed here before?
Yes No

If yes, please provide date(s) and details:

If yes, give dates
From to

Are you legally eligible for employments in this country? Yes No

Date available for work

What is your desired salary range or hour rate of pay?

$ Per

Type of employment desired: Full-Time Part-Time Seasonal Temporary Education Co-op

Will you relocate if job requires it? Yes No

Employment History

Starting with your most recent employer, provide the following information.

Employer

Phone:

Dates employed:
month /year to month /year

Street address: City
State

Compensation (Starting)

Starting job title/final job title

Hourly Salary $ per

Immediate supervisor and title (for most recent position held)

Commission/Bonus/Other Compensation $

May we contact for reference? Yes No Later

Compensation (Final)

Why did you leave?

Hourly Salary $ per

Commision/Bonus/Other Compensation $

Summarize the type of work performed and job responsibilities

What did you like most about your position?

What were the things you liked least about the position?

Employer

Phone:

Dates employed:
month /year to month /year

Street address: City
State

Compensation (Starting)

Starting job title/final job title

Hourly Salary $ per

Immediate supervisor and title (for most recent position held)

Commission/Bonus/Other Compensation $

May we contact for reference? Yes No Later

Compensation (Final)

Why did you leave?

Hourly Salary $ per

Commision/Bonus/Other Compensation $

Summarize the type of work performed and job responsibilities

What did you like most about your position?

What were the things you liked least about the position?

Employer

Phone:

Dates employed:
month /year to month /year

Street address: City
State

Compensation (Starting)

Starting job title/final job title

Hourly Salary $ per

Immediate supervisor and title (for most recent position held)

Commission/Bonus/Other Compensation $

May we contact for reference? Yes No Later

Compensation (Final)

Why did you leave?

Hourly Salary $ per

Commision/Bonus/Other Compensation $

Summarize the type of work performed and job responsibilities

What did you like most about your position?

What were the things you liked least about the position?

Skill and Qualifications

Summarize any special training, skills, licenses and/ or certificates that may assist you in performing the position for which you are applying.

Word Processing                     Year:
Spreadsheet                            Year:
Presentation                            Year:
E-mail                                       Year:

Internet                                     Year
Other          Year:
Other          Year:
Other          Year:

Education Background

Starting with your most recent school attended, provide the following information

School (include City & State)

Year Completed

Completed

GPA Class Rank

Major/Minor

Diploma GED
Degree
Certification
Other

References

List name and telephone number of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.

Name	Title	Relationship to You	Telephone	Number of Years Known

List special accomplishments, publications, awards, etc.

Exclude information that would reveal race, color, religion, sec, national origin, citizenship, age, mental or physical disabilities, veteran/reserve national guard or any other similarly protected status.

In your current or a prior job, have you ever written instructions or directions to be followed by employees or customers?

Yes No Not Applicable

If yes, please explain:

Is there any other job-related information you want us to know about you?

Applicant Statement

Signature of Applicant Date

Position(s) applied for Date

Referral Source

Walk-in	Government Employment Agency	Private Employment Agency
Employee	Relative	School
Advertisement - Source		Other

Name of person who referred you IF APPLICABLE

Applicant Information

Last name: First Name Middle Telephone #

Address

City

State

Zip Code

Male Female

Please check one of the following Equal Employment Opportunity Identification Groups:

American Indian / Alaskan Native	Hispanic/Latino (white race only)	White	Black/African American
Native Hawaiian / Other Pacific Islander	Hispanic / Latino (all other races)	Asian