EMPLOYMENT HISTORY A
List your most recent employment first, followed by previous job experience(s). Use a separate sheet of paper if needed.
XYZ Warehouse Co
Drive forklift, locate items in warehouse,
place orders on pallets for shipment.
N/A
555-987-6543
Pay: $10/hr
Supervisor:
Hy-Vee
Placed items neatly on shelves, assisted
customers, and straightened aisles.
Moved to Cedar Rapids
555-012-3456
Pay: $6/hr
N/A
N/A
N/A
Telephone:
Pay: N/A Supervisor: N/A
SKILLS & QUALIFICATIONS A
Other qualifications such as special skills, abilities, or honors that should be considered, including types of computers,
software, and other equipment you are qualified to operate or repair:
Diagnostic and repair experience on engines, pneumatic tools, production machines, and motors.
Some knowledge of HVAC systems and basic electrical equipment. Forklift license.
Professional licenses, certifications, or registrations:
Certified Maintenance & Reliability Technician (CMRT), Society for Maintenance & Reliability Professionals May 2018
REFERENCES A
List three professional references:
Mike Greene Cedar Rapids, IA 555-987-2865 mgreene@xyzcorp.com Shift Supervisor 10
Name Address Telephone E-mail Occupation Years Known
Sherri Roberts Monticello, IA 555-987-2865 sherryroberts@gmail.com Manager (Hy-Vee) 12
Name Address Telephone E-mail Occupation Years Known
Russ Martinez Cedar Rapids, IA 555-987-1234 russm@kirkwood.edu Maintenance Professor 2
Name Address Telephone E-mail Occupation Years Known
NOTICE TO APPLICANT A
I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that falsified statements,
misrepresentations, or omissions may be grounds for dismissal.
I authorize investigation of all statements contained herein and the references listed above to give any and all information concerning my previous
employment and any pertinent information they may have, personal or otherwise. I release all parties from all liability for any damage that may
result from furnishing this information to you. I understand that I may make a written request for information derived from background and
reference checks.
If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have
a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. If hired, employment is for no definite
period and may be terminated at any time without prior notice. I understand and agree to the information shown above.
John A. Smith 08/15/2018
Signature of Applicant Date