BEACH MOLD & TOOL - JOB APPLICATION FORM
Personal Information 
Last Name * : Middle Name :
First Name * : Present Street Address * :
Maiden Name : City * :
Phone : : State * :

Zip * Code

Are you 18 yrs of age or older? * : Yes No Have you ever been convicted of a felony? : Yes No
E-mail Address : If yes, please explain :
Location Desired:   New Albany, IN
Emporia, VA
Employment Desired 
Position * : Date you can start :
Minimum Salary you will accept : Are you legally eligible for employment in * the United States? : Yes No
Are you employed now? * : Yes No If so, may we inquire of your* present employer?  : Yes No
Ever applied to this company before? : Yes No If yes, when? (month/year) :
Ever Worked for this company before? : Yes No If yes, when? (month/year) :
How or by whom were you referred to our company? : Are you available to work overtime?* : Yes No
      Are you available to work any shift?* : Yes No
Education
High School  : (name, city and state) Dates Attended : From:  To:
Subjects Studied : Did you Graduate? : Yes No
College : (name, city and state) Dates Attended :
From: To:
Subjects Studied : Did you Graduate? : Yes No
Trade, Business, or Correspondence : (name, city and state) Dates Attended :
From: To:
Subjects Studied : Did you Graduate? : Yes No
Other : (name, city and state) Dates Attended :
From: To:
Subjects Studied : Did you Graduate? : Yes No
THE AGE DISCRIMINATION ACT OF 1967 PROHIBITS DISCRIMINATION ON THE BASIS OF AGE WITH RESPECT TO INDIVIDUAL WHO ARE AT LEAST 40 YEARS OF AGE.
Military (Complete this section if you served in the U.S. Armed Forces.)
Branch of Service : Period of Active Duty : (list month & year) (list month & year)
From: To:
Describe your duties and any special training: : Rank at Discharge  :

 

Date of Final Discharge :
Employment Experience (Start with your present or most recent employer)
1.Employer : (Name, City and State) Name and Title of Immediate Supervisor :
Position or Job Title : Salary :
Telephone Number of Employer : Period Employed : From: To:
Reason For Leaving :    
2.Employer :

(Name, City and State)

Name and Title of Immediate Supervisor :  
Position or Job Title : Salary :
Telephone Number of Employer : Period Employed : From: To:
Reason For Leaving :        
3.Employer : (Name, City and State) Name and Title of Immediate Supervisor :  
Position or Job Title : Salary :  
Telephone Number of Employer : Period Employed : From: To:
Reason For Leaving :    
4.Employer : (Name, City and State) Name and Title of Immediate Supervisor :
Position or Job Title : Salary :
Telephone Number of Employer : Period Employed :
From: To:
Reason For Leaving :    
Personal References
1. Name : Position :
  Relationship : Years Acquainted :
2. Name : Position :
  Relationship : Years Acquainted :
List the names of three persons you are not related to and by whom you have NOT been employed.
1. Name : City, State : Years Acquainted
Occupation : Telephone :

2. Name : City, State : Years Acquainted
Occupation : Telephone :
3. Name : City, State : Years Acquainted
Occupation : Telephone :

BACK TO TOP

Thank you for your interest in employment at Beach Mold & Tool Inc. You will be contacted if your qualifications match our job criteria. Please ensure that the contact information you provide is accurate.

Beach Mold & Tool, Inc.999 Progress Blvd. New Albany, Indiana 47150 USA Ph: (812) 945-2688; Fax: (812) 944-3705
Copyright 2005 Beach Mold & Tool, Inc. All rights reserved.