Executive Board Meeting

Military Service & Background

Have you served in any branch of the U.S. Military?

Yes

No

Branch

Years of service

Type of discharge

Have you ever been convicted of a felony?

Yes

No

Please explain

Are you a citizen of the United States?

Yes

No

Please list your current employer

Company

Address

City

State

Salary/Hourly wage

Phone

Supervisor

Dates employed

Reason for leaving

Duties

Add previous employment

Company Name

City

State

Phone

Dates employed

Reason for leaving

Add previous employment

Company Name

City

State

Phone

Dates employed

Reason for leaving

Please list any prior clerical (computer experience and software skills), and industrial experience (equipment operator experience, including but not limited to forklift, heavy lift, yard tractor, or cranes)

Have you been employed by 1351 in the past?

Yes

No

When were you employed and reason for leaving?

Have you ever been employed by any other union or ILA local?

Yes

No

Have you ever been known by any other name?

Yes

No

What Name?

Explalin

Please Explain

Education

Do you have any Trade School Experience?

Yes

No

Please Explain

Have you attended college?

Yes

No

Please Explain

References and Availability

Please list information for 3 references we can contact that have known you for at least 3 years, who are not relatives or former employers, and can speak on your skills and experiences

Full Name

Phone

Relationship

Full Name

Phone

Relationship

Full Name

Phone

Relationship

Are there any hours during available days that you are unable to work?

Yes

No

Please explain

Emergency contact name and phone number

Full Name

Phone

Relationship

Email

Executive Board Meeting

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Military Service & Background

Education

References and Availability

Emergency contact name and phone number

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