P. O. BOX 840352 • HOUSTON, TX 77284-0352  • (713) 672-7878 • FAX (713) 672-9843 www.nationallsinc.com  email: customer.service@nationallsinc.com

 

 

1.  Full Legal Name:

      

     

     

 

 

Last Name

First

Middle

 

2.  Home Phone:

(   )

     

Business Phone

(   )

 

3.  Street Address:

     

 

 

     

     

     

6. E-mail Address:  

 

 

City

State

Zip

 

 

4. Education:

 

4a.  Highest school grade completed:

1  2  3  4  5  6  7  8  9  10  11  12

 

4b.  Please check the boxes that apply to you:

 

 

 

        High School Graduate  

 

 

        GED   

 

 

        Some College  

 

 

         College Graduate  

 

 

5. Name and Location of Educational Institution:

Degree Received

Major / Specialty

Dates Attended

 

5a.

   

   

   

 

5b.

   

   

   

 

5c.

   

   

   

 

 

 

6.  If you plan to complete an educational program in the future, then indicate the degree or program to be completed

 

6a. Completion Date:

   

7. Work Experience:  Start with the most recent work experience.  Describe your knowledge, skills and abilities that demonstrate your qualifications for the position for which you are applying, especially work with warehouse experience.

 

 

7a.  Job Title

     

 

Job Duties:

 

  Employer Name

 

 

     

 

 

  Employer  Address

     

 

 

 

     

 

 

 

     

Phone

     

 

 

 

 

 

  Supervisor / Manager

     

 

 

  Title

     

 

 

  Final Salary

     

 

 

  Dates (Month/ Year)

     

To

     

 

Reason for leaving:

 

  Hours / Week                     

    

 

 

 

 

 

 

 

7b.  Job Title

     

 

Job Duties:

 

  Employer Name

     

 

 

  Employer Address

     

 

 

 

     

 

 

 

     

Phone

     

 

 

 

 

 

  Supervisor / Manager

     

 

 

  Title

     

 

 

  Final Salary

     

 

 

  Dates (Month/ Year)

     

To

     

 

Reason for leaving:

 

   Hours / Week                 

    

 

8.  Job Skills:  Use the following space to provide any additional information that you think would be helpful in our evaluation of your job application.  This can include specialized training, seminars, workshops, accreditations, special achievements or valuable skills:

 

 

 

 

 

 

 

 

9.  References:

List the full name, address, phone number and relationships of up to three persons that you’d like to use as a reference:

 

Full Name

Address

Phone Number

Relationship

 

   

   

   

 

   

   

   

 

   

   

   

 

10.  Miscellaneous Information:

 

10a.  Would you be able to pass a drug test at this very moment?   Yes   No

10b.  Will you have any issues working weekends, nights, and extended hour shifts?:   Yes   No 

 

10c.  What do you do with your time outside of work?  

10d.  Will transportation to and from work be an issue?:   No   Yes

10e.  Why do you want this labor intensive job?

11.  Compliance with the Immigration Reform and Control Act requires that you are you legally eligible for employment in the United States?

 Yes    No. 

 

Please note that under the Immigration Reform and Control Act of 1986, that you may be required to fill out a certification verifying that you are eligible to be employed and verifying your identity.  You may also be required to provide documentation should you be employed.

 

 

12. Operating Machinery:  Do you have experience operating a:

      

        Pallet Jack

 Yes  No

        Fork Lift

 Yes  No

        Clamp Machine

 Yes  No

        Split Machine

 Yes  No

13. Prior Convictions:

13a.  Have you ever been convicted of any violation of law, including moving traffic violations:   Yes  No

   If yes, then please provide the following:

Describe the Offense :      

Statute / Ordinance (if known):

Date of Charge: ;  Date of Conviction

County, City,  and State of Conviction:

 

14.   Work Start Date:  When will you be available to start work?  If you are available as soon as you have given two weeks notice, then no dates are necessary.

 

  

Month

  

Day

  

Year

15.  Job Application Certification:

I hereby certify that all entries on this job application and any attachments are true and complete.  I also agree and understand that any falsification this information may result in my forfeiture of employment.

 

I understand that all information on this job application is subject to verification and I consent to criminal history and background checks.  I also agree that you may contact references and educational institutions listed on this application

Dated

     

Job Applicant Signature