Online Hiring Application

Please note: It is important that you complete all parts of the application. If your application is incomplete or does not clearly show the experience and/or training required, your application may not be accepted. If you have no information to enter in a section, please write N/A.

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Alternate Phone

If under 18, please list age:

Email *

Job Type

What days are you available to work. Please select as many as apply.

I am seeking:

Full-time employment
Part-time employment
Full- or Part-time employment

How many hours can you work weekly?

Can you work nights?

Date available to begin:

Additional Information

Have you ever been employed by LeRoy Tool & Die in the past?

I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States.

Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgement to a felony?

If yes, please explain:

Do you have a valid driver's license?

If yes, what is your driver's license number?

If yes, in what state was your driver's license issued?

Education

High School

High School Address

Address Line 1

City

State

Zip Code

Diploma Earned at High School?

College or Business/Trade School

College or Business/Trade School Address

Address Line 1

City

State

Zip Code

What degree did you earn at College or Business/Trade School?

If you have additional relevant education, please upload a PDF of the information:

Click or drag a file to this area to upload.

Military

Have you ever been in the Armed Forces?

Date Entered

Are you a now a member of the National Guard?

Discharge Date

If you have military experience, what was your specialty?

Work Experience

Please list ALL work experiences beginning with your most recent employment. Upload additional PDF documents if there is not enough room on this form.

Company 1 Name

Company 1 Address

Address Line 1

City

State

Zip Code

Company 1 Phone

Name of Last Supervisor at Company 1

How many hours a week did you work for Company 1?

Start Date for Company 1

Starting Salary for Company 1

Ending Date for Company 1

Ending Salary for Company 1

Your Last Job Title at Company 1

Reason for Leaving Company 1 (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at Company 1.

May we contact Company 1?

Company 2 Name

Company 2 Address

Address Line 1

City

State

Zip Code

Company 2 Phone

Name of Last Supervisor at Company 2

How many hours a week did you work for Company 2?

Start Date for Company 2

Starting Salary for Company 2

Ending Date for Company 2

Ending Salary for Company 2

Your Last Job Title at Company 2

Reason for Leaving Company 2 (be specific):

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at Company 2.

May we contact Company 2?

Upload PDF of additional Work Experience

Click or drag a file to this area to upload.

References

Please exclude relatives and former employers from references.

Name of Reference 1 *

First

Last

Phone of Reference 1 *

Name of Reference 2 *

First

Last

Phone of Reference 2 *

Name of Reference 3

First

Last

Phone of Reference 3

Name of Reference 4

First

Last

Phone of Reference 4

Submit Your Application

I certify with the submission of this LeRoy Tool & Die Hiring Application that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with LeRoy Tool & Die terminated. In addition, if I am hired by LeRoy Tool & Die, I must submit a valid Social Security Number to the Human Resources Department on employment.