JR Machine, Inc. is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

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Name *

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Middle

Last

Email *

Phone *

Address *

Address Line 1

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Zip Code

Is this your permanent address? *

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Permanent Address *

Address Line 1

City

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Zip Code

Are you legally eligible for employment in the U.S.? *

• Yes
• No

All new hires will be required to provide proof of eligibility to work in the US.

Have you ever been convicted of a felony? *

• Yes
• No

If yes, please explain

Employment

Desired Position

Date Available for Work

How did you hear of this opening?

• Employee/Friend
• Social Media
• Video
• Postcard
• Website
• Other

Are you willing to work second shift?

• Yes
• No

Employee / Other

How did you hear of this opening additional information

Have you worked for this company before?

• Yes
• No

Are you looking for full-time or part-time employment?

• Full-time
• Part-time

Do you have any relatives who are or were employed by this company?

• Yes
• No

Part-time Availability

Education

High School

School Name

School Location

Major/Degree Earned

College

Name of College/University

College Location

Major/Degree Earned

Trade School

Name of Trade School

Trade School Location

Major/Degree Earned

In addition to your education and employment history, please include any other skills, qualifications, or experiences we should consider.

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Work Experience

Company Name *

Address *

Address Line 1

City

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Starting Position

Ending Position

Starting Wage

Ending Wage

Supervisor's Name

Supervisor's Phone

Employment Start Date *

Employment End Date *

Brief Description of Your Job Responsibilities

Reason for Leaving

Are you still working here?

• Yes
• No

Employment 2

Company Name *

Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Starting Position

Ending Position

Starting Wage

Ending Wage

Supervisor's Name

Supervisor's Phone

Employment Start Date *

Employment End Date *

Brief Description of Your Job Responsibilities

Reason for Leaving

Are you still working here?

• Yes
• No

Employment 3

Company Name *

Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Starting Position

Ending Position

Starting Wage

Ending Wage

Supervisor's Name

Supervisor's Phone

Employment Start Date *

Employment End Date *

Brief Description of Your Job Responsibilities

Reason for Leaving

Are you still working here?

• Yes
• No

References

Name

Title/Occupation

Relationship

Phone

Upload Your Resume *

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Certify *

• I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any false information on this application may be grounds for refusal to hire or termination of employment if hired based on untrue statements.

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