Line
General Information
Employment Desired
Education
Name and Location Years Attended Did You Graduate? Subjects Studied
High School
College
Trade, Business or Correspondence
General
A felony conviction does not automatically exclude you from consideration
References
List the names of three persons not related to you whom you have known at least 1 year.
Name Address and Phone Number Business Years Known
Former Employers
List below your last four employers, starting with most recent.
Month and Year Name and Address Salary Position Reason for Leaving
Additional Information
Do you have a valid driver's license?
Can you provide your own transportation to work?
Are you able to stand for extended periods of time and lift up to 40 lbs?
Are you able to drive to locations within 60 miles to work?
Are you willing to submit for a drug test if required?
Do you own safety shoes?
What is your shift preference? (check all that apply) 1st 2nd 3rd
Authorization
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I authorize Benchmark National Corporation to investigate facts stated in this application.

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