PTi - World Class Extrusion Systems

Name (Last, First, MI)

Date

Address (Street, City, State, Zip)

Daytime Phone Number

Evening Phone Number

Position Desired

Desired Salary

Available Start Date

Have you previously been employed by PTi?

Have you previously applied to PTi?

Are any of your relatives currently employed by PTi?

Are you 18 years of age or older?

Are you able to perform the job duties described?

Are you willing to travel

Are you willing to relocate

Can you, upon employment submit documentation verifying your identity and your legal right to work in the U.S.?

During the last ten years, have you been convicted of a crime other than a minor treaffice offense? (you are not obligated to disclose sealed or expunged records of conviction or arrest)

If yes, please explain:

How did you hear about PTi?

Name and Location of High School

Did you graduate?

Name and Location of Vocational School

Course of Study at Vocational School

Number of Years at Vocational School

Did you Graduate Vocational School?

Name and Location of College

College Course of Study

Number of Years at College

Did you Graduate College?

Degree

Name and Location of Graduate School

Course of Study at Graduate School

Number of Years at Graduate School

Did you Complete Graduate School?

Degree Obtained

Training / Certification / License

Sponsoring Organization

License Number

Indicate your competence in the areas listed below using the following scale:
Internet

Microsoft Excel

Microsoft Word

Microsoft Power Point

Database

Please specify:

Financial

Mechanical Drawing / Drafting

Graphic Design

Publishing

Other Computer / Technology

Please Specify:

Employer 1

Employer 1 Address

Employer 1 Phone Number

Employer 1 Job Title

Employer 1 Dates of Employment

Employer 1 Supervisor

Employer 1 Ending Salary

May we contact Employer 1?

Reason for Leaving Employer 1

Duties and Responsibilities at Employer 1

Employer 2

Employer 2 Address

Employer 2 Phone Number

Employer 2 Job Title

Employer 2 Dates of Employment

Employer 2 Supervisor

Employer 2 Ending Salary

May we contact Employer 2?

Reason for Leaving Employer 2

Duties and Responsibilities at Employer 2

Employer 3

Employer 3 Address

Employer 3 Phone Number

Employer 3 Job Title

Employer 3 Dates of Employment

Employer 3 Supervisor

Employer 3 Ending Salary

May we Contact Employer 3?

Reason for Leaving Employer 3?

Duties and Responsibilities at Employer 3

Reference 1 Name

Reference 1 Relationship

Years Acquainted with Reference 1

Reference 1 Phone Number

Reference 2 Name

Reference 2 Relationship

Years Acquainted with Reference 2

Reference 2 Phone Number

Reference 3 Name

Reference 3 Relationship

Years Acquainted with Reference 3

Reference 3 Phone Number



I hereby authorize PTi to verify the accuracy of information provided on this application and to obtain reference information concerning my work performance. I hereby release PTi from any and all liability of whatever kind and nature which, at any time co