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First
Name:
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Last
Name:
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Address:
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City:
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State:
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Zip:
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Phone:
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E-mail:
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Desired
Position:
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If
Other:
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Attach
resume:
ACCEPTABLE FORMATS: .doc, .wpd,
.txt, .wks, .pdf , word
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Employment
History

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Please list
chronologically, beginning with most recent experience.
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Employer:
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Address/City:
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From
(MM/YYYY):
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To
(MM/YYYY):
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Supervisor:
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Phone:
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Salary:
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Type
of Work:
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Reason
for Leaving:
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Employer:
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Address/City:
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From
(MM/YYYY):
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To
(MM/YYYY):
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Supervisor:
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Phone:
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Salary:
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Type
of Work:
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Reason
for Leaving:
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Employer:
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Address/City:
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From
(MM/YYYY):
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To
(MM/YYYY):
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Supervisor:
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Phone:
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Salary:
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Type
of Work:
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Reason
for Leaving:
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Education

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Personal
Information

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Member of the Drug-Free
Workplace Network. Pre-Employment Drug Testing is a Requirement.
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Are
you legally authorized to work in the U.S.?:
(If hired, you will be required to provide proof of
work authorization.)
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Yes
No
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Are
you at least 18 years of age?:
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Yes
No
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Briefly
describe skills you may have that you acquired in other employment or armed
forces:
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Have
you ever been convicted of a crime (felony)?:
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Yes
No
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If
yes, give details:
(Convictions are not automatic bar to employment)
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If
you are experienced operator of any office machines or equipment, please
list:
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Typing
speed?:
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wpm
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Shorthand?:
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wpm
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If
you are experienced operator of any plant machines or equipment, please list:
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Do
you have any other skills you wish to mention?:
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Are
you presently employed?:
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Yes
No
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If
so, may we contact your present employer?:
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Yes
No
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If
hired, when would you be available?:
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Employment
References

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List individuals familiar
with your job qualifications (No relatives or personal friends).
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1)
Name of Reference:
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2)
Name of Reference:
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Occupation:
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Occupation:
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Address:
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Address:
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City/State/Zip:
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City/State/Zip:
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Phone:
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Phone:
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Relationship:
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Relationship:
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How
long known:
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How
long known:
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Invitation
to Identify for Affirmative Action Purposes

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Edstrom
Industries, Inc., is committed to the employment and
advancement of minorities, females, and individuals with disabilities and
veterans. If you fall into one of these protected classifications, we invite
you to identify yourself and receive coverage under our company's Affirmative Action Plan. You may inform us of your desire
to benefit under the program at this time and/or any time in the future.
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Gender:
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Male
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Female
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Indicate
The Appropriate Race/Ethnic Group:
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How
Were You Referred To This Job:
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Please read carefully before submitting your
application
All information contained
in this application is true and correct to the best of my knowledge and
belief. I understand that misrepresentations or omissions of any kind may
result in denial of employment or be cause for subsequent dismissal if I am
hired. I authorize the company to investigate my responses on this
application and contact any or all of my former employers or any individuals
familiar with me or my employment background for the purpose of verifying any
information, I have provided and/or for the purpose of obtaining any
information, whether favorable or unfavorable, about me or my employment. I
voluntarily and knowingly fully release and hold harmless any person or
organization that provides information pertaining to me or my employment. I
understand that upon receiving a job offer, a physical examination and drug screening
may be required. (Note: If this is a job requirement, you will be notified.)
Regardless of whether or not I become employed by the company, I recognize
that this application is not and should not be considered a contract of
employment. I understand that employment at the company is on an at-will
basis and that my employment may be terminated with or without cause, and
without notice, at any time, at my option or the company's unless
specifically provided otherwise in a written employment contract. I further
understand that no company employee or representative has the authority to
enter into a contract regarding duration or terms and conditions of
employment other that an officer or official of the company, and then only by
means of a signed written document. We have a policy of no smoking on the
premises.
Check this box to certify that you have read and
accept the above statement.
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