Step 1 of 7 0% Date* MM slash DD slash YYYY Name* First Middle Last Maiden Present Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long?* Social Security Number* TelephoneCell PhoneEmail If under 18, please list agePosition applied for* Salary Desired* Employment Desired* FULL-TIME ONLY PART-TIME ONLY FULL-OR PART-TIME When available for work?* Do you currently have a relative working for Neill-LaVielle or Bearings of Kentucky?* Yes No Have you ever been employed before?*YesNoFrom MM slash DD slash YYYY To MM slash DD slash YYYY Are you legally eligible for employment in this country?*Choose:YesNoWill you travel if the job requires it?*Choose:YesNoWill you work overtime if the job requires?*Choose:YesNoHave you ever pled “guilty” or “no contest” to, or been convicted of a crime?*Choose:YesNo MILITARYHAVE YOU EVER BEEN IN THE ARMED FORCES?*Choose:YesNoARE YOU NOW A MEMBER OF THE NATIONAL GUARD?*Choose:YesNo DO YOU HAVE A DRIVER’S LICENSE?*Choose:YesNoWhat is your means of transportation to work?* Driver’s license # State of IssueAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCommercial (CDL) Expiration Date Month Day Year Have you had any accidents during the past three years?*Choose:YesNoHow Many?Have you had any moving violations during the past three years?*Choose:YesNoHow Many? Skills(please check those that apply)Please Check Those That Apply Word Excel Outlook PowerPoint Internet Explorer CNC Porduction Saw CDL Driver's License Forklift Overhead Crane Able to Read Measuring Tape Hazmat 10 Key Typing Personal ReferencesPlease list three personal references that are not related to you.Name First Last Title Relationship to You PhoneNumberName First Last Title Relationship to You PhoneNumberName First Last Title Relationship to You PhoneNumber Education BackgroundHigh School Please Include Name and LocationYears CompletedCollege Please Include Name and LocationYears CompletedMajor/Degree Bus. Or Trade School Please Include Name and LocationYears CompletedMajor/Degree Professional School Please Include Name and LocationYears CompletedMajor/Degree WORK EXPERIENCEPlease list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. May we contact your present employer?*Choose:YesNoExplain any gaps in your employmentHave you ever been fired or asked to resign from a job?*YesNoName of Employer First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone of Immediate SupervisorEmployment From MM slash DD slash YYYY To MM slash DD slash YYYY SalaryYour last job title Reason for leaving (be specific) List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:HAVE YOU EVER BEEN PLED “GUILTY” OR “NO CONTEST” TO , OR BEEN CONVICTED OF A CRIME?*YesNoIf yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation
