Southern Textiles & Laminating, Inc.

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Application

Name

Mailing Address

Home Phone

Cell Phone

Are you a citizen of the United States? Yes No

If not, are you authorized to work in the United States? Yes No

Who do you know at Southern Textiles and Laminating?

What is the position for which you are applying?

Are there any hours or days you cannot work? Please explain.

Are you looking for full time, part time, or both?

How did you hear of this job opening?

Education: Please list the last grade completed. If you have a diploma or GED, please list the year of completion and school name.

Do you have your own transportation to work? Yes No

Do you have experience using a forklift? Yes No

Job duties will require heavy lifting, stooping, bending and repetitive motions. Will you be able to perform these job duties? Yes No

Do you have any experience with machinery or textile manufacturing? If so, please explain:

Can you easily adapt to using unfamiliar computer programs? If possible, please list programs you are familiar using.

Please list what you consider to be your strengths that are applicable to the workplace:

Are you currently employed? Yes No

May we contact your present employer? Yes No

MOST RECENT EMPLOYMENT EXPERIENCE

Company

Dates employed

Phone

Job title

Supervisor

Work performed

Reason for leaving

PREVIOUS EMPLOYMENT EXPERIENCE

Company

Dates employed

Phone

Job title

Supervisor

Work performed

Reason for Leaving

REFERENCE #1

Full Name

Company Name

Relationship

Contact number / email

REFERENCE #2

Full Name

Company Name

Relationship

Contact number / email

I hereby state that the information furnished above is true and accurate. Falsified information will be grounds for immediate dismissal. Furthermore, I authorize the Company and its representatives to inquire of all former employers or others who know me or know of me. It is agreed and understood that the Company and its agents may conduct background evaluations to ascertain any and all information of concern, whether same is of record or not, and I release all employers and persons named herein from all liability for any damages on account of their furnishing such information. I also acknowledge that a negative drug screen test is a condition of employment. If I quit within the first 90 days of employment, I understand the cost of the drug screen will be deducted from my final paycheck.

Signed Name

Signed Date