Peacock Manufacturing Company

Employment Application Form

Date of Application

Date Available*

Last Name*

First Name*

Middle Name

Street Address*

Address Line 2

City*

Zip*

Phone Number*

Other Number

Email Address*

What is your desired salary?*

How did you hear about us?

Type of Employment Desired*

Full-Time

Part-Time

Temporary

Are you legally eligible for employment in this country?*

Yes

No

Are you over the age of 18?*

Yes

No

Can you work overtime, including nights and weekends?*

Yes

No

Can you work any shift?*

Yes

No

Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accomodation?*

Yes

No

Have you ever worked for this company before?*

Yes

No

Do you know anyone who works for our company?*

Yes

No

Employment History

Provide the following information for your past for employers.

No Employment History

Have you ever been terminated from employment or asked to resign by an employer?*

Yes

No

Employer {{i}}

Start Date*

End Date*

Company Name*

Phone*

Job Title*

Street Address

Address Line 2

City*

Zip*

Immediate Supervisor Name and Title*

May we contact this employer?*

Yes

No

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Education & Skills

Skills & Qualifications

Education {{i}}

Name of School*

City*

Years Completed*

Did you graduate?*

Degree / Diploma / GED / Certficiate*

Area of Study/Major*

Specialized Training, Skills, or Extra Curricular Activitites

+ Add Another School

Professional References

Persons not related to you who are familiar with your experience, training and character. Examples: employers, supervisors, teacher or co-workers.

Reference {{i}}

Name and Title*

Relationship*

Phone*

Email*

Years Known*

+ Add Another Reference

Resume

Attach your resume in Word (*.doc, *.docx) or PDF (*.pdf) format.

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Peacock Manufacturing Co., LLC to hire me. If I am hired, I understand that either Peacock Manufacturing Co., LLC or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no represntative of Peacock Manufacturing Co., LLC has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Peacock Manufacturing Co., LLC true and complete information on this application. No requested information has been concealed. I authroize Peacock Manufacturing Co., LLC to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

I certify that I have read and fully understand the proceeding

Signature

Date