Poynette Ironworks Inc.

Employment Application


PERSONAL INFORMATION
Date of Application*
Position Applying for*

Name & Address*
Phone*        Phone 2
Email

Start Date

Desired Salary

If you are under 18, and it is required, can you furnish a work permit?* Yes No NA
If no, please explain

Have you ever been employed here before?* Yes No
If yes, give dates & positions

Are you legally eligible for employment in this country?* Yes No

Have you ever pled "guilty" or "no contest" to, or been convicted of a crime?* Yes No
If yes, please provide date(s) and details
Answering "yes" to these questions does not constitute an automatic bar of employment.Factors such as date of the offense,
seriousness and nature of the violation, rehabilitation and position applied for will be taken into account.

EMPLOYMENT HISTORY
Start Date
End Date
Employeer Name & Address
Phone
Immediate Supervisor & Title

May we contact for reference? Yes No
Job Title
Ending Salary
Summarize work preformed & job responsibilities
Reason for Leaving

Start Date
End Date
Employeer Name & Address
Phone
Immediate Supervisor & Title

May we contact for reference? Yes No
Job Title
Ending Salary
Summarize work preformed & job responsibilities
Reason for Leaving

Start Date
End Date
Employeer Name & Address
Phone
Immediate Supervisor & Title

May we contact for reference? Yes No
Job Title
Ending Salary
Summarize work preformed & job responsibilities
Reason for Leaving

Start Date
End Date
Employeer Name & Address
Phone
Immediate Supervisor & Title

May we contact for reference? Yes No
Job Title
Ending Salary
Summarize work preformed & job responsibilities
Reason for Leaving

SKILLS & QUALIFICATIONS
Summarize any training, skills, licenses and/or certificates that may qualify you as being able to preform job-related
functions in the position for which you are applying.

EDUCATIONAL BACKGROUND

School
Year
Completed

Level of Completetion

Course of Study

REFERENCES

Name*

Title*

Relationship to Candidate*

Phone*
Years
Known*

Send Application:

By clicking the submit button below, I cerity that all of the information provided by me on this application is true and
complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my
application may be rejected and, if I am employed, my employement may be terminated at any time. In consideration
of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment
and compenstation can be terminated, with or without cause,and with or without notice, at any time, at either my
or the company's option. I also understand and agree that the terms and conditions of my employment may be changed,
with or without cause, and with or without notice, at any time by the company.