Employment Application

* indicates required field

First name *

Last name *

Email *

Phone *

Secondary phone

Referred by

Present address *

City *

State *

ZIP *

Last address

City

State

ZIP

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

Yes No

Are you currently employed?*

Yes No

If yes, may we contact your employer?*

Yes No

Employment Desired

Position

Salary desired

Date you can start

Ever apply to City Glass Company before?*

Yes No

Ever work for City Glass Company before?*

Yes No

If yes, when

Name of last City Glass supervisor

Reason for leaving City Glass

Education History

High school

College

Trade or business school

General Information

Subject of special study/research work

Special training, certifications, licenses

Special skills, foreign languages, etc...

Military Service Record

Have you ever served in the U.S. Armed Forces?*

Yes No

Former Employers (chronologically list last three employers)

Name of Present or Last Employer

Job Title

Employer Email

Employer Address

City

State

ZIP

Starting Date

Leaving Date

Name of Previous Employer

Job Title

Employer Email

Employer Address

City

State

ZIP

Starting Date

Leaving Date

Name of Previous Employer

Job Title

Employer Email

Employer Address

City

State

ZIP

Starting Date

Leaving Date

How did you find out about this position?*

Employment Agency State Employment Office Newspaper College Placement Friend Walk-in Online Ad Website Other

719-634-2891