XPAC - Employment Application

Position Desired
Full Name
Home Address
City/State/Zip
Telephone Number
Email Address
How did you hear of XPAC?
Are you 18 years of age or older?	Yes No
If hired, can you provide written evidence that you are authorized to work in the U.S.?	Yes No
Have you worked for us before?	Yes No
If yes, please describe when and in what position
Please check shifts available?	1st 2nd
Please check days available for work	Monday	Tuesday
	Wednesday	Thursday
	Friday	Saturday
Education
High School
Name/Location
Course
Years Completed
Degree/Diploma
College
Name/Location
Course
Years Completed
Degree/Diploma
Technical or Other
Name/Location
Course
Years Completed
Degree/Diploma
Employment Record - Please list in order of the most recent
Company Name/Address
Kind of Work
Dates (Started/Ended)
Rate of Pay
Reason for leaving
_________________________________________________________
Company Name/Address
Kind of Work
Dates (Started/Ended)
Rate of Pay
Reason for leaving
_________________________________________________________
Company Name/Address
Kind of Work
Dates (Started/Ended)
Rate of Pay
Reason for leaving
_________________________________________________________
Company Name/Address
Kind of Work
Dates (Started/Ended)
Rate of Pay
Reason for leaving
Work References - (i.e. Previous employer or Supervisor)
1st Reference
Name
Title
Company
Address
Phone No.
2nd Reference
Name
Title
Company
Address
Phone No.
Additional Information / "On The Job" Experience
Warehouse	Yes #of Years
Forklift	Yes #of Years
Receiving	Yes #of Years
Shipping	Yes #of Years
Assembly	Yes #of Years
CDL License	Yes #of Years
Power Tools	Yes #of Years
Woodshop	Yes #of Years
Inventory	Yes #of Years
Packaging	Yes #of Years
Computer	Yes #of Years
Clerical	Yes #of Years

Please list any additional information that relates to your ability to perform the job for which you have applied - such as licenses, professional memberships, hobbies, etc.

Upon submitting the application, you will be returned to the homepage.

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