Employment Form
Please complete the online application form, and attach your resume, if appropriate.
 
*First Name:
*Last Name:
*I'm applying for:
*Address:
*City:
*State:
*Zip Code:
*Phone:
Fax:
Cell Phone:
*Email:
*Available for:
*Expected Pay Rate:
*Date Available:
*Who referred you to us?:
*Are you legally authorized to work in the U.S.?:
*Have you been convicted of a criminal offense:
If yes to previous, when, where and reason.:
*Have you ever been employed here before?:
If previously employed, list date of employment::
*Do you have sewing experience?:
Describe sewing experience if applicable:
*Do you have supervisory experience?:
Describe supervisory experience if applicable:
*Do you smoke?:
*Please List H.S. Name:
*Please indicate grade of High School completed:
College Attended:
Please indicate years of college completed:
Graduate School Attended:
Please indicate years of graduate school completed:
*Reference Name 1 (professional not relatives):
*Reference 1-Company:
*Reference 1-Relationship:
*Reference 1-Address:
*Reference 1-Phone:
*Reference Name 2 (professional not relatives)::
*Reference 2-Company:
*Reference 2-Relationship:
*Reference 2-Address:
*Reference 2-Phone:
*Reference Name 3 (professional not relatives)::
*Reference 3-Company:
*Reference 3-Relationship:
*Reference 3-Address:
*Reference 3-Phone:
*Previous employment-Company 1:
*Previous employers address:
*Previous employers phone:
*Supervisor:
*Job Title:
*Starting Salary:
*Ending Salary:
*Responsibilities:
*Employed from (Date):
*Employed to (Date):
*Reason for leaving:
*May we contact your supervisor for a reference?:
*Previous employment-Company 2:
*Previous employers address:
*Previous employers phone:
*Supervisor:
*Job Title:
*Starting Salary:
*Ending Salary:
*Responsibilities:
*Employed from (Date):
*Employed to (Date):
*Reason for leaving:
*May we contact your supervisor for a reference?:
*Previous employment-Company 3:
*Previous employers address:
*Previous employers phone:
*Supervisor:
*Job Title:
*Starting Salary:
*Ending Salary:
*Responsibilities:
*Employed from (Date):
*Employed to (Date):
*Reason for leaving:
*May we contact your supervisor for a reference?:
Military Service-Branch:
Served from (date):
Served to (date):
Rank at Discharge:
Type of discharge:
If other than honorable, explain:
*Emergency Contact-#1:
*Emergency contact phone number:
*Emergency contact relationship:
*Emergency Contact-#2:
*Emergency contact phone number:
*Emergency contact relationship:
Emergency Contact-#3:
Emergency contact phone number:
Emergency contact relationship:
Resume:
 
 
 
 
 
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   Fire-Dex, LLC. 780 South Progress Drive, Medina, Ohio 44256 | (330) 723-0000 | Fax (330) 723-0035 - Developed by Chad Allan Consulting, LLC