Application Job Application About You Name * First Last * Last Have you gone by a different name before? Yes (please list)Yes (please list) No Email * Home Phone Mobile Phone Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal How did you hear about us? * Facebook Indeed Jobsinbrookings.com LinkedIn Current Employee (please list)Current Employee (please list) Previous Employee (please listPrevious Employee (please list Are you 18 years of age? * Yes No Are you authorized to work in the USA? * Yes No Position Position you are applying for: * Positions within Counterpart, Inc - (To be sure of what openings we have, ask Human Resources. If there are no openings, we will keep your application on file for 3 months.) Employment Desired * Full-time Part-time Full- or Part- time Shift * Day Shift (M-Th 7AM - 4:30 PM and Friday 7 AM - 11 AM) Night Shift (M-Th 4:30 PM - 3 AM) Are you available for overtime? * Yes No Have you applied here before? * Yes No When are you available to start work? * Experience Document your applicable experiences in the areas below. Metal Fabrication Welding Powder Coating Forklift Commercial Driver's License Yes (list endorsements:_Yes (list endorsements:_ No Software (Excel/Word) CAD CAM Software Other Education Name of High School * Address of High School * Graduated? * Yes No Last Year Attended 9 10 11 12 Did you attend College or a Technical School? * Yes, College Yes, Technical School No Name of School Address of School Area of Study Did you graduate? Yes No Have you served in the military? * Yes No Military Service Branch Dates Start to End Rank at discharge Type of discharge Work Experience 1 Company Name * Date * From Date * To Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Reason for leaving * Supervisor's Name * Phone * Work Experience 2 Company Name * Date * From Date * To Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Reason for leaving * Supervisor's Name * Phone * Work Experience 3 Company Name Date From Date To Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Reason for leaving Supervisor's Name Phone Professional Reference 1 Name * Address Phone * Professional Reference 2 Name Address Phone Professional Reference 3 Name Address Phone Signature IMPORTANT- PLEASE READ AND SIGN Counterpart Inc. complies with Federal Drug Free Workplace requirements. All applicants are required to take a drug screen and physical after you are offered and accept a position at our organization. Any applicant with a confirmed positive test result will be denied employment. If you have any questions or concerns you may contact Human Resources. I attest that the information that I have stated is factual and complete to the best of my knowledge. I understand that if any information I have given is knowingly falsified, I will be denied employment or im Signature signature keyboard Clear Date If you are human, leave this field blank. Submit Δ
