Required Fields Are Marked in Red

Date

Position applying for

First Name

 Middle  

Last Name

Address

City, State, Zip Code

Phone

Other Contact

What source led you to make an application with us?   WI Job Bank Newspaper ad Friend Web site Internet

Employment History - List most current employer first

Employer 1

Address

City

Employed from

 to 

Name of Supervisor

Type of work performed

Reason for leaving

Present or last wage

Employer 2

Address

City

Employed from

 to  

Name of Supervisor

Type of work performed

Reason for leaving

Present or last wage

Employer 3

Address

City

Employed from

 to  

Name of Supervisor

Type of work performed

Reason for leaving

Present or last wage

Education

High School

Name

Location

Major Course

Diploma or Degree?

  YesNo

Choose last year completed

7  8  9  10  11  12

College

Name

Location

Major Course

Diploma or Degree?

YesNo

Choose last year completed

1  2  3  4+

Business/Trade School

Name

Location

Major Course

Diploma or Degree?

YesNo

Years attended

Other

Name

Location

Major Course

Diploma or Degree?

YesNo

Years attended

Are you legally authorized to work in the US? YesNo

(Note: You will be required to furnish documents to verify your eligibility for employment in accordance with federal and state laws.)

Are you at least 18 years of age? YesNo

Have you ever been convicted of a felony crime? YesNo

List any plant machinery or equipment you operate proficiently (i.e. forklift, packaging/milling equipment)

List any computer software you operate proficiently.

Other skills.

Are you presently employed? YesNo

If so, may we contact your present employer? YesNo

If hired, when would you be available for work?

Wage requirement?

References

Reference Name 1

Occupation

Address

City, State, Zip Code

Phone

Reference Name 2

Occupation

Address

City, State, Zip Code

Phone

Reference Name 3

Occupation

Address

City, State, Zip Code

Phone

I certify that the information provided on this application is true and correct without any material omissions or misstatements of any kind. I understand that any misleading or incorrect statements may be grounds for termination if I am employed. I understand that a medical examination based on the requirements of the position for which I am being considered may be required, and drug testing may be included as part of the regular pre-employment screening.

I hereby authorize Didion Milling, Inc. to request and receive information from any persons or companies I have listed on this application.

I Agree   

Equal Employment Opportunity Applicant Data Record

Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, veteran status, disability or any other basis prohibited by law.

As employers/government contractors, we comply with government regulations and affirmitive action responsiblities. To help us assure accurate data for governmental compliance, please fill out the information below. This information will be only be used in accordance with federal regulations. This form will be kept in a Confidential File separate from the Application for Employment.

Check one

Male  Female

Race/Ethnic group

----------------------------------------------------------- White Black/African American Hispanic or Latino (white race only) Hispanic or Latino (all other races) American Indian/Alaskan Native Asian Native Hawaiian or other Pacific Islander