Name*

First Last

Email*

Address

Street Address City State ZIP Code

Phone

Are you prevented from lawfully becoming employed in this country because of Visa or immigration status?*

Yes
No

Are you 18 years or older?*

Yes
No

Employment Desired

Desired Position*

Available start date*

Are you currently employed?*

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No

If so, may we contact your current employer?

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No

Have you ever applied for a job at York Haven Fabricators before?*

Yes
No

If the above answer is "Yes," please state when and where.

I was referred by

Education - High School

Name and Location

No. of Years Attended

Did you graduate?

Yes
No

Subjects Studied

Education - College

Name and Location

No. of Years Attended

Did you graduate?

Yes
No

Subjects Studied

Education - Trade, Business, or Correspondence School

Name and Location

No. of Years Attended

Did you graduate?

Yes
No

Subjects Studied

General

Subjects of special study or research work

Special Skills

U.S. Military or Naval Service

Rank

Present membership in National Guard or Reserves

Resume

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Attach any additional documents, such as certifications

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Former Employers

List last three employers, starting with the last one first:

Employer Name

Salary

Position

Reason for Leaving

Employer Name

Salary

Position

Reason for Leaving

Employer Name

Salary

Position

Reason for Leaving

Which job did you like best and why?

References

Give the names of three persons not related to you, whom you have known at least one year.

Name*

First Last

Business*

Address

Street Address City State ZIP Code

Years Acquainted*

Name*

First Last

Business*

Address

Street Address City State ZIP Code

Years Acquainted*

Name*

First Last

Business*

Address

Street Address City State ZIP Code

Years Acquainted*

In Case of Emergency Notify

Name

First Last

Phone

Address

Street Address City State ZIP Code