Job App

First Name

Middle Initial

Last Name

Primary Phone

Ext

Secondary Phone

Ext

Address 1

Address 2

How long have you lived at this address? 0-1 yrs 1-5 yrs 5+ yrs

Driver License

Dl Type

Is your driver license currently valid? Yes No

Age Range

Are you a citizen, or are you legal to work in the U.S.? Yes No

Have you ever been employed by Priefert? Yes No

Start Date

End Date

Position Applying For

Mig Welder

Maintenance

Mechanic

Machinist

Clerical

General Labor

Construction

Heavy Equipment

Electrical

Sales

Truck Driver

Information Technology

Mt. Pleasant

Dallas/Fort Worth

Benton, Arkansas

Boise, Idaho

Full Time

Part Time

Temp Work (Seasonal)

Pay/Salary Desired

Date Available To Start

Are you currently employed? Yes No

If hired, do you expect to be working for any other business or job? Yes No

Are there any days or hours you would be unable or unwilling to work? Yes No

If yes, please specify

If position requires you to operate company equipment or vehicle, do you permit us to obtain your driving record? Yes No

Would you be willing and able to report on time every day or on a regular basis? Yes No

Have you ever been disciplined or received verbal or written warnings for absenteeism or tardiness? Yes No

Have you ever been fired or asked to resign from a job? Yes No

Select the highest grade completed

Did you graduate high school? Yes No

High School Diploma? Yes No

Enter number of years completed

Did you graduate college? Yes No

College Major

College Minor

College Degree

Number of Months Attended

Did you graduate trade school? Yes No

Diploma or Certificate

If you did not graduate, why did you leave high school or college?

Are you planning to pursue further studies? Yes No

If so, where and what courses?

List any scholastic honors, offices, held and and activities involved in during high school and college. (Please exclude those which may reflect race, sex, color, religion, national origin, disability, sexual orientation, or other protected status.)

Please describe any other special courses, seminars or training which may enable you to better perform the duties of the position for which you are applying.

Position Applied for Related Work Experience

Employer City

Employer State

Employer Zip

Employer Phone

Nature of Business

Title

Supervisor Name

Supervisor Title

Start Date

End Date - Leave blank if presently employed at job

Start Pay (No Ranges)

End Pay (No Ranges)

Describe Duties Performed

Employer City

Employer State

Employer Zip

Employer Phone

Nature of Business

Title

Supervisor Name

Supervisor Title

Start Date

End Date

Start Pay (No Ranges)

End Pay (No Ranges)

Describe Duties Performed

Employer City

Employer State

Employer Zip

Employer Phone

Nature of business

Title

Supervisor Name

Supervisor Title

Start Date

End Date

Start Pay (No Ranges)

End Pay (No Ranges)

Describe Duties Performed

Have you ever served in the military? Yes No

What branch of the military did you serve in?

MOS

Address

City

State

Address

City

State

Address

City

State

I certify that my answers to the foregoing questions are true and correct without any consequential omissions of any kind whatsoever. I understand that if I am employed, any false, misleading or otherwise incorrect statement made on this application form or during any interviews may be grounds for my immediate discharge. I agree that if I am employed, I will abide by all the rules and regulations of the company. I understand that the taking of drug and alcohol tests, when given pursuant to company policy, are a condition of continued employment and refusal to take such test when asked will be grounds for my immediate termination. I understand that if I am employed, my scheduled shift is subject to change at any time. I also understand that my employment is at-will and may be terminated by myself or by the company at any time for any reason at all, with or without prior notice.

By checking this box, I acknowledge that I have read and understand the above statement.

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