Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

Hourly

Salary

Employment Desired *

Full-Time

Part-Time

Seasonal

Do you consent to a background check? *

(Note: If selected, a separate FCRA-compliant authorization form will be provided.)

Yes

No

Are you legally eligible to work in the U.S? *

Yes

No

Have you ever been convicted of a felony that is relevant to the position for which you are applying? *

Yes

No

Graduated/GED: *

Yes

No

Graduated

Yes

No

Check all that apply

Forklift

Floor Pallet

Automatic Lifter

Shrink Wrapping

Product Packaging

Liquid Products

Basic Computer

Label Printer

Phone *

Country

(###)

###

####

From *

MM

DD

YYYY

To *

MM

DD

YYYY

Phone

(###)

###

####

Date

MM

DD

YYYY

Date

MM

DD

YYYY

Phone

(###)

###

####

From

MM

DD

YYYY

To

MM

DD

YYYY

Phone *

Country

(###)

###

####

Phone

(###)

###

####

Phone

(###)

###

####

I authorize SEMCO to contact my former employers listed above regarding my work history and job performance. *

Yes

No

I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated. *

Yes

Date *

MM

DD

YYYY

Full Name *

First Name

Last Name