Northwest: Employment

NORTHWEST TOOL AND DIE EMPLOYMENT APPLICATION
Equal access to programs, services is available to all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a representative of the Human Services Department.

Please complete the application below, and press "submit" to send us the application.

Please provide the following contact information:

Position(s) applied for
Name (last, first, middle)
Social Security #
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone
Other Phone
E-mail

If you are under 18, and it is required, can you furnish a work permit?
	yes no
If no, please explain

Have you ever worked here before? If yes, give dates and positions:


Are you legally eligible for employment in this country ?
	yes no

Date available for work
Desired salary range
Type of employment desired	Full-time Part-time Temporary
	Seasonal Educational Co-op

Are you able to meet the attendance requirements of the position ?
	yes no

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

If yes, please give details :
Answering "yes" to these questions does not constitute an automatic bar to employment. Factors such as the date of offense , seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account.

Driver's License number if driving an essential job function:

State

EMPLOYMENT HISTORY
Provide the following information of your past four (4) employers, assignments, or volunteer activities,
starting with the most recent.

Job #1	From To
Employer		Phone
Job Title		Supervisor
Address		Summarize the nature of work performed and job responsibilities
Start Salary
Final Salary
May we contact this employer for a reference? yes no later
Reason for leaving

Job #2	From To
Employer		Phone
Job Title		Supervisor
Address		Summarize the nature of work performed and job responsibilities
Start Salary
Final Salary
May we contact this employer for a reference? yes no later
Reason for leaving

Job #3	From To
Employer		Phone
Job Title		Supervisor
Address		Summarize the nature of work performed and job responsibilities
Start Salary
Final Salary
May we contact this employer for a reference? yes no later
Reason for leaving

Job #4	From To
Employer		Phone
Job Title		Supervisor
Address		Summarize the nature of work performed and job responsibilities
Start Salary
Final Salary
May we contact this employer for a reference? yes no later
Reason for leaving

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

EDUCATIONAL BACKGROUND
(if job related)

	(name and location)	(yrs completed)	(graduate?)	(course of study)
High School
College
Other

REFERENCES
Include name, phone number, and number years known for each reference

By pressing "submit", and sending this application to Northwest Tool and Die, you certify that you have read and understand the application statement on file at Northwest.