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Personal Information

Name (First, Middle, Last):

Date:

Phone Number:

Email:

Address:

Date of Birth (Optional):

City:

State:

ZIP:

How did you hear about LeTourneau Plastics?:

Employment Desired

Position(s):

Date available:

Schedule:DaysNightsPart-timeFull-time

Salary/Wage Desired

Have you applied to this company before?YesNo

When?

Education

	Name / Location	Years Attended	Area(s) of Study	Graduated?
High School				YesNo

Trade/ Tech School				YesNo

University/ College/ Grad School				YesNo

Other Information
Additional Training / Certification / License / Special Study or Research / Activities:

FOUR MOST RECENT EMPLOYERS (Beginning with most recent)

Month/Year to Month/Year	Name and City/State of Employer	Ending Salary/Wage	Position	Reason for Leaving

To:


To:


To:


To:

References: Provide three references

	Name	Phone	Employer & Position	Relationship (non-relative)	Years Acquainted (minimum 1 year)
1
2
3

I authorize investigation into all statements contained in this application. I understand that the falsification, misrepresentation, or omission of fact on this application, or on any other accompanying or required documents, may be cause for denial of employment or immediate termination of employment, regardless of when or how it was discovered. I understand and agree that my employment stands for no definite period and may, at the discretion of the employer, be terminated at any time, without advance notice.

Applicant Signature

Date

Application Form

Application Form

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LeTourneau Plastics, Inc.

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