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




2.  Home Phone:

(   )


Business Phone

(   )


3.  Street Address:







6. E-mail Address:  








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  






        Some College  



         College Graduate  



5. Name and Location of Educational Institution:

Degree Received

Major / Specialty

Dates Attended



















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

















  Supervisor / Manager








  Final Salary




  Dates (Month/ Year)





Reason for leaving:


  Hours / Week                     









7b.  Job Title



Job Duties:


  Employer Name




  Employer Address

















  Supervisor / Manager








  Final Salary




  Dates (Month/ Year)





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


Phone Number















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.








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



Job Applicant Signature