Online Job Application

Please complete this form to apply for job postings at mid-states bolt and screw.

Personal Data
* Name:
* Position Applying for:
E-mail Address:
Present Address:
City:
State:
Zip Code:
Country:
* Daytime Phone(###-###-####):
Evening Phone(###-###-####):
Salary requirements:
Date available:
Have you attained the age of 18?	Yes No
Are you legally authorized to work in the United States?	Yes No
Have you ever been convicted of a crime? If Yes, please explain.	Yes No
Do you have any relatives employed by Mid-States Bolt & Screw Co.? If Yes, please list.	Yes No
Applicants may be tested for drugs as a part of the pre-employment process. Are you willing to submit to a substance abuse test?	Yes No
Availability
Are you available to work: Full-Time Yes No Weekends Yes No	Are you availble on:
	MON.	Yes No
	TUES.	Yes No
	WED.	Yes No
	THURS.	Yes No
	FRI.	Yes No
	SAT.	Yes No
Have you ever been employed by Mid-States Bolt & Screw Co. If Yes, when?	Yes No
Education and Activities
HIGH SCHOOL
Name and Location of School:
Major Course:
GPA:
Degree:
COLLEGE
Name and Location of School:
Major Course:
GPA:
Degree:
GRADUATE / OTHER
Name and Location of School:
Major Course:
GPA:
Degree:
Scholastic Honors: (Indicate from which school)
Special Skills
Office equipment operated:
Typing speed:
Computer Skills:	Yes No
Word Processing Systems:
Software Types:
Do you have a valid Driver's License?	Yes No
What is your license class?
Do you have access to reliable transportation?	Yes No
Please list any other special skills, experience, and/or training that you possess.
Military Service
Were you in the armed services?	Yes No
If Yes, what branch?
Rank at discharge:
List duties in the service including special training.
Employment History
Please list previous employers. List most recent employer first. Send additional email to Mid-States Human Resources department if necessary.
May we contact your present employer?	Yes No
Company:
Supervisor :
Starting salary :
Salary ending :
Dates of employment:	from to
Title of position and duties performed:
Phone number:
Street address:
City, State & Zip:
Reason for leaving:
May we contact your previous employer?	Yes No
Company:
Supervisor :
Starting salary :
Salary ending :
Dates of employment:	from to
Title of position and duties performed:
Phone number:
Street address:
City, State & Zip:
Reason for leaving:

Company:
Supervisor :
Starting salary :
Salary ending :
Dates of employment:	from to
Title of position and duties performed:
Phone number:
Street address:
City, State & Zip:
Reason for leaving:

Company:
Supervisor :
Starting salary :
Salary ending :
Dates of employment:	from to
Title of position and duties performed:
Phone number:
Street address:
City, State & Zip:
Reason for leaving:
Please explain any special compensation (including bonus) on any of the jobs you have held.
List any award or recognition you received for your job performance, professional, contributions or memberships.
Business References
Give the names, titles, addresses and phone numbers of three business and/or personal references. Please limit to one personal reference. No relatives. (We will not contact present employer without prior approval.)
1. Name:
Company and Address:
Phone:
Years known:

2. Name:
Company and Address:
Phone:
Years known:

3. Name:
Company and Address:
Phone:
Years known:
CERTIFICATION: I am aware that any omissions, falsifications, misstatements, or misrepresentations in this application may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I understand that Mid-States Bolt and Screw Co. may investigate my work and personal history to verify all data given on this application. I certify that to the best of my knowledge and belief all of the statements contained herein and on any attachment s are true, correct, complete, and made in good faith. * Type Name: EMPLOYMENT AT WILL: I am aware that this application does not in any way constitute a contract or agreement of any kind. I agree and I am fully aware that any future employment at Mid-States Bolt and Screw Co. will be at an at will status, meaning my employment and compensation can be terminated at any time, for any reason with or without cause or notice. I am aware that no supervisor, manager or any other representative of this employer other than the President has any authority to enter into any employment agreement with me for any reason or for any specific period of time, or to make any agreement contrary to the forgoing provision; and further, that any such agreement must be made in writing by the president. PRE_EMPLOYMENT TESTING: As an applicant of this company, I am fully aware and understand that they Department of Labor permits non-remunerated pre-employment testing. I am aware that I may be reviewed and tested and not paid for any review or test period by this company. I am also aware and understand that I am NOT an employee of this company during this review/testing period and that I am not performing work or services in any way. If I have been determined to have passed by pre-employment review/testing period, as solely determined by management and then received and accepted an offer of employment form this company, only then will I be considered an employee and my remuneration begins at that time. NON-COMPETE/NON DISCLOSURE: I am fully aware, completely understand, and agree that if I am hired I may be asked to sign and conform to the non-compete and non-disclosure policies of the company as a condition of employment. * TYPE NAME: BY TYPING YOUR NAME AND SUBMITTING THIS APPLICATION YOU ARE ACKNOWLEDGING ALL ABOVE STATEMENTS ARE CORRECT.
* = Required

If you experience difficulties with this form please send an e-mail to Mid-States Human Resources.

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Online Job Application

mid-states bolt and screw co. 4126 Somers Drive | Burton, MI 48529 Telephone: (810) 744-0123 | Toll Free: (800) 482-0867 | Fax: (810) 744-3798 © Copyright 2003, Mid-States Bolt & Screw Co.

mid-states bolt and screw co.
4126 Somers Drive | Burton, MI 48529
Telephone: (810) 744-0123 | Toll Free: (800) 482-0867 | Fax: (810) 744-3798
© Copyright 2003, Mid-States Bolt & Screw Co.