NorthWest - Apply

Employment Application

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination.

Today's Date

Full Name *

First

Last

Address

Telephone

Email

Position for which you are applying?

What special qualifications do you have?

Are you 18 years or older?

Yes
No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?

Yes
No

Wage Desired:

When would you be available to start working?

Do you have a valid driver’s license?

Yes
No

Driver's Licence # , Class, State, Expiration Date

Do you have any relatives or friends currently employed by NorthWest General Engineering?

Yes
No

If yes, who?

Have you ever been discharged or asked to resign from a position?

Yes
No

If yes, explain:

Are you able to perform the essential functions of the job for which you are applying?

Yes
No

If no, explain:

Military Service – Were you or are you in the military?

Yes, Currently active
Yes, Previously but not active
No

If yes, what branch of service?

Discharge Date (if applicable)

Present membership in National Guard or Reserves (if applicable):

Date obligation ends:

Previous Job Experience 1 – Name & Address of Company

Date Worked From – Date Worked To:

List Your Duties:

Reason for Leaving:

Previous Job Experience 2 – Name & Address of Company

Date Worked From – Date Worked To:

List Your Duties:

Reason For Leaving:

Previous Job Experience 3 – Name & Address of Company

Date Worked From – Date Worked To:

List Your Duties:

Reason For Leaving:

Reference 1:

Reference 2:

I understand that any omission or misrepresentation with respect to this information may be cause for denial or immediate termination of employment.

Digital Signature – Please sign by typing in your full name.