Production Line Worker Application Please enable JavaScript in your browser to complete this form.Name *FirstLastSocial Security No. *Sex: *MaleFemalePrefer not to answerDate of Birth: *Email: *Phone Number: *Current Address: *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePermanent/Previous Address:Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code-------- Educaton History --------Grammar School:Name & Location of SchoolYears AttendedDid You Graduate?Subjects StudiedHigh School:Name & Location of SchoolYears AttendedDid You Graduate?Subjects StudiedCollege:Name & Location of SchoolYears AttendedDid You Graduate?Subjects StudiedTrade, Business, Correspondence School:Name & Location of SchoolYears AttendedDid You Graduate?Subjects StudiedGeneral Information:U.S. Military or Naval Service:FirstLast-------- Employment History --------Date you can start: *Salary Desired: *Are You EmployedYesNoIf So, May We Inquire of Your Present Employer?YesNoEver Applied to DiRusso's Sausage Inc. Before?YesNoIf Yes, When? / Where?FirstLastFormer Employment (We require you provide a minimum of 2):(List below the last 4 employers, starting with the most recent one first)Name & Address of Employer *From: *Until: *Salary or Hourly RatePosition: *Reason for Leaving: *Former Employment (2):Name & Address of Employer: *From: *Until: *Salary or Hourly Rate:Position: *Reason for Leaving: *Former Employment (3):Name & Address of Employer:From:Until:Salary or Hourly Rate:Position:Reason for Leaving:Former Employment (4):Name & Address of Employer:From:Until:Salary or Hourly Rate:Position:Reason for Leaving:Relevant Experience:Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgement to a felony?YesNoIf you answered "yes," please explain:-------- References --------Please give the names of three persons, not related to you, whom you have know at least one year.Name (1):Phone Number (1):Relationship (1):Years Known (1):Name (2):Phone Number (2):Relationship (2)Years Known (2):Name (3):Phone Number (3):Relationship (3):Years Known (3):-------- RESUME UPLOAD --------If you have one, please upload a copy of your resume in MS Word or PDF file formats below. Click or drag a file to this area to upload. We can accept resumes in MS Word or PDF files only-------- AUTHORIZATION --------"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by and authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws" By filling your name and checking the box below you agree to the authorization terms above and allow DiRusso's Sausage Inc. to process your application accordingly.Authorization: *I Agree to allow DiRusso's Sausage Inc. to process my application.Date: *Name: *FirstLastPlease tell us where you found our job listing: *Submit
