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s44 <br /> ilt State&Federal Law Prohibits <br /> SKIIIEO TRADES AN EQUAL OPPORTUNITY EMPLOYER Discrimination Based On Age <br /> Sex or National Orgin <br /> NAMEELArST,FIRST MIDDLE tip - 1 -' Y SDfJAI SECURRYMIUMBER – DATE OF PIR7II nmce usQRly <br /> L�.•�. ��Y�: .§��4 L\r �•It�1•' 3`! �, t �7� 1.9p WA13 CopYoII.R.'sEl <br /> STREET ADORES <br /> i • f! ''w_� !S 4 I ' SaFMy Rules❑ M-a <br /> 7 <br /> 142-CITY /'N STATE Zip DruE S Alcohol 13 <br /> , Employee Handbook 1.1 <br /> HOME PHONE MOBIL C PHDNE S / fe [MAI!L ADDRESS ) RIGHFTR WORK iN US ALIfN REG/ ALIEN REG EXP DATE BaLlytDund U <br /> �,.4F. yL r ` ',r✓ l�;'+ \ '0 1 S J 1,.. Z�,� r QYE3—E w CoMidenllailtyO <br /> Benefits O client Bener[Is Waivet U <br /> IN CASE OF EMERGENCY,NOTIFY:NAME / ADDRESSr/xf''I" L��y '""'•-��{� L-� TELEPHONE Marltel Slatus:O Single <br /> Gf ' q Marrlod O DWarced <br /> t. <br /> V(I14AFf}�USTRE ARE YOU AIMLYiNG EOR? DATEAVREIAUIF MINRATEPEBHR HAVE YOU EVER CEEN REffEREtEp <br /> 1, CONVICTED OF A FELONY? C� , d - <br /> HLYNDIO <br /> yrs "n <br /> f(n)RFAR W US? Piave you ever worked for summit U Sex: Vet Stakn11or1 natE: Rale:ll Caucasian LJ Mian Q African-America/Black <br /> Skilled Trades Belolel---,4, L9 Malr E]I.'spanlr/W lno Q American Indian/Alaskan Nattve <br /> Two lif Mar LaOthedget Got <br /> WHICHDAYS ARE YUUAVAIJABLE10W0,KFUE'TVIE CITIES AVA.IABLLIOWORK IN 1SiSHIF! 1 r IJAVAILADLELONG TERMASSIGNMENT <br /> Zr4(7N-C1`Tur-,U WED.0 THU U FRI U SAT CJ SUN U •2N0 SHIFT _AM TO—PM ❑VJCLL ACCEPT SAME DAY ASSIGNMENT <br /> r t r <br /> WORK SKILL-Check your skills and kind of work you have clone J 3RO SHEFT � ' ANT TO_FM ❑TRANSPORTTION AVAILA13LE7 LI YES U NG <br /> tl�A017;NISTRATIHCSS <br /> AisTANr LI ELFCTRICUAN U 11VACIEELFIER LI HVACJOURI,F-YV-4L1i �� U S1IEErMETAL EOCAPMENT Driver's License? <br /> -f CLECTRICAI HELPER U174LECTITIRAt A51PRE11TICF.. ;J ItVACL/FP0nCR L HVACSCRV:CVIZCit tl SH EETMETALAPPRE"ITCI! U Iiarrlllal 4,Y Ls uNo <br /> LI E!ECTRIC AL JOURNEYMAN 'J E1 CCTIEI.IAL MASTL1I J EWM'LIF-tIl'OCELFI J EQUIPMENT 0PERA10R hPPRLNTICE La SHEET IAETAL HI111ER U Toils LICENSE NUMBER: <br /> L y 1 f <br /> LI I(1W VOl TACE ELECIRECIAN U FE F.CTRiCAt I AHORER -.,U EQUIPMENT OPERAS J GENL:RAI I ATIORFQ U 51*"METAL-JOURNEYMAN U Glasses <br /> L7. !AE CANE APP E! IAACHDHST .Ia NILMOEIi 7 PLL1MBFR APPRFr,TICrCl SHFFT METAL.MASTER U Stant Too Wark[Soots FJ C(ll_ <br /> U VICHINI'MOLD MAKER �.!'MA;RINT'MEHATOR 'J IILIIIADFR FIFLPER LI PLLJM01 R JOURNEYMAN Ll SHEET METAL LAIIORER U Other{Ploaso List)-. U Clan A <br /> L1 MACIRNIST 1 ARORER U MACHINr oil CR U PLUMUER UAUOREN J PLUMBER N%STF:R Ll WELDER U Dan ES <br /> IJ M!AArrI`ISHfi1001 AND DIE MAKER :J M.ACIlttll:TOOL AND DIE J VIPEIITIER LJ FCPEFR-I LRAPPRLHTICE U WEIOUR FLAT <br /> f! L1nIrl�I IIAIICI:VIORK MAI:UELCTUriRC IAU10 C'R J PIPEFI1TLI4 1ILLPE U PiVCFITTFR JOtMth YPJAN LJ WELOEN I ADOREN <br /> J liVAC U HVAC l,PPR!-NTICE J PIPE FITTER LAUOr•J MPEFITTER MA IFR U o1HER <br /> _Previnr Empl-lismr•nt NrlTe o Ern:lrrynr Phone ar Addrr-Ss Patin Rate P ition . ftpsolyfor Leaving <br /> {corn I o <br /> f ram Eu <br /> Educt:..';nr Name of SrhoDl JI�egroe Graduati:A? I.Nt all Licenses and Certifications Expiration Date <br /> hereby authorize you and all former employers,and ethers given by me as a reference,to answer all questions and to give all information in <br /> ronnectinn with this appliraticn or in any way concerning inn I agree, if employed by;you,that if ever I make claims against you for personal injuries, <br /> Upon your request I shall submit to drug screens and examinations by physicians of your selection.Your employment of me may be terminated by you <br /> at any time I.Adthmit any Ilobility 1,o me except for wages and salary as have been earned by me at the date of such termination. I understand that it is <br /> my responsibility to notify you of my availabily on a weekly basis at a minimum, and if I do not, I will considered unavailable for work. <br /> Signature: f Date: f <br />