Kirby - Employment Application

EMPLOYMENT INFO

* denotes required field

Today's Date:	8/28/2008
*Type of Position Applying For:
Other Interest or Skills:
*Date Available:	(e.g. 08/21/2006)
*Salary Desired:

* denotes required field

*Please select the last grade completed:
High School
Name:
City:
State:
Major / Degree:
Type of Degree or Certificates:
College
Name:
City:
State:
Major / Degree:
Type of Degree or Certificates:
Tech School
Name:
City:
State:
Major / Degree:
Type of Degree or Certificates:
Post Graduate
Name:
City:
State:
Major / Degree:
Type of Degree or Certificates:
Other
Name:
City:
State:
Major / Degree:
Type of Degree or Certificates:
Other special skills or professional registrations:
Computer / Software Skills
Microsoft Word:
Microsoft Excel:
Microsoft PowerPoint:
Microsoft Access:
10-Key Touch Calculator:
Typing WPM:
Other Software Skills / Experience:

* denotes required field

THIS SECTION MUST BE FULLY COMPLETED BEFORE YOU CAN BE CONSIDERED FOR EMPLOYMENT Describe Your Duties in Detail as to Type of Work, Responsibilities and Number of People Supervised
Name and Location of Present or Last Employer
*Name:
*Address:
*City:
*State:
*Zip:
*Name of Supervisor:
*Telephone:
*Your Exact Job Title:
Duties Performed:*
Dates of Employment
*From:	Month: Year:
*To:	Month: Year:
*Rate of Pay:
*Reason For Leaving:
Name and Location of Previous Employer
Name:
Address:
City:
State:
Zip:
Name of Supervisor:
Telephone:
Your Exact Job Title:
Duties Performed:
Dates of Employment
From:	Month: Year:
To:	Month: Year:
Rate of Pay:
Reason For Leaving:
Name and Location of Previous Employer
Name:
Address:
City:
State:
Zip:
Name of Supervisor:
Telephone:
Your Exact Job Title:
Duties Performed:
Dates of Employment
From:	Month: Year:
To:	Month: Year:
Rate of Pay:
Reason For Leaving:

* denotes required field

Reference 1.
Full Name:
Address:
City:
State:
Zip:
Telephone: (include area code)
Occupation:
Reference 2.
Full Name:
Address:
City:
State:
Zip:
Telephone: (include area code)
Occupation:
Reference 3.
Full Name:
Address:
City:
State:
Zip:
Telephone: (include area code)
Occupation:
Name and Contact Information of Person Not Already Listed, who would most likely always know how or where to reach you:
First Name:
Middle Name:
Last Name:
Address:
City:
State:

*First Name:
Middle Name:
*Last Name:
*Telephone: (include area code)
Present Address
*Street & Number:
*City:
*State:
*Zip:
Permanent Address
Street & Number:
City:
State:
Zip:
Emergency Contact
*Name:
*Address: (street & number)
*City:
*State:
*Zip:
*Phone: (include area code)
Work Phone: (include area code)
*Have you been employed by Kirby Building Systems / Magnatrax Corp. before?
Yes No Dates: From: To: (e.g. 08/21/2006)
*Do you have relatives working for Kirby Building Systems?
Yes No
Name:
Dates: To: From: (e.g. 08/21/2006)
Name:
Dates: To: From: (e.g. 08/21/2006)
*Are you at least 18 years of age? Yes No
*Are you either a a U.S. citizen or authorized to be employed in the United States? Yes No
(Applicants must be able to provide the identity and work eligibility documents required to comlet INS Form I-9)
*Have you had a criminal felony conviction? Yes No
(A criminal conviction does not necessarily disqualify an applicant from employment consideration)
*Were you referred by someone for a job at Kirby Building Systems?
Yes No Name(s):