Columbia Industries Inc.
3rd and Oak Streets
Berwick, PA 18603
570-759-1291
570-759-9392 fax
fectruck@verizon.net

 Application for Employment
The Human Rights Code prohibits discrimination in employment because of race, national or ethnic origin, religion, age, sex, marital status, family status, disability or conviction for an offense for which a pardon has been granted.
   
Last Name:
First Name:
M.I.:
 Email:    
   
Address:
City:
State:
Zip:
     
     
             
Phone:
Cell:
     
Social Security No:          
             
Position applying for:          
How did you learn of opening:          
Do you want to work: Full Time Part Time          
Specify when if part time:          
Have you worked here before:
If yes when?:
     
Position held:          
             
Available date:          
Experiences and Skills:
Are you bondable: Yes No          
             
Educational Background
         
Type of School
School Name
City, State
Graduation Date
Major
Secondary school:
College:
Post graduate:
Business or trade:
Other:
Prior Work History
   List in order, last or present employer first
Dates
Company Name
Rate of Pay
Supervisor's Name
Reason for Leaving
From
To
Company's Address
Start
Finish
Supervisor's Title
Describe in detail the work you did:
Dates
Company Name
Rate of Pay
Supervisor's Name
Reason for Leaving
From
To
Company's Address
Start
Finish
Supervisor's Title
Describe in detail the work you did:
Dates
Company Name
Rate of Pay
Supervisor's Name
Reason for Leaving
From
To
Company's Address
Start
Finish
Supervisor's Title
Describe in detail the work you did:

Can we contact all of your former employers?: If not, which employers can we contact:

             
Personal References
Give the names of at least 3 persons who can supply information pertinent to you job performance (excluding relatives).
      
Name: Occupation: Address: Phone:
             
Occasionally the spaces provided on an application make it difficult for an individual to adequately summarize his/her complete background. To assist us in finding the proper position for you in our company, use this space to summarize any additional information necessary to describe your full qualifications:
      
   
Why do you want this position?:
Job Experience
1 = Experienced, little or no supervision required.
2 = Some experience, moderate supervision required.
3 = Little or no experience.
Mig Welding flat: One Two Three          
Mig Welding vertical: One Two Three          
Mig Welding overhead: One Two Three          
Stick Welding flat: One Two Three          
Stick Welding vertical: One Two Three          
Stick Welding overhead: One Two Three          
Aluminum Welding Mig: One Two Three          
Aluminum Welding Tig: One Two Three          
Drill Press: One Two Three          
Horizonal Bandsaw: One Two Three          
Vertical Bandsaw: One Two Three          
Vertical Mill: One Two Three          
Lathe: One Two Three          
Press Brake: One Two Three          
Punch Press: One Two Three          
Squaring Shear: One Two Three          
NC or CNC Turret Punch: One Two Three          
NC or CNC Backgauge: One Two Three          
Initial Pinch Roll: One Two Three          
Notcher: One Two Three          
Pedastal Grinder: One Two Three          
Bench Grinder: One Two Three          
Cutting Torch: One Two Three          
Plasma Torch: One Two Three          
Tracer Torch: One Two Three          
Blueprint Reading: One Two Three          
Layout: One Two Three          
Bend Allowance Calculation: One Two Three          
Roll Allowance Calculation: One Two Three          
NC or CNC Programming: One Two Three          
Machine Setup: One Two Three          
Jig or Fixture Building: One Two Three          
Automotive Wiring: One Two Three          
Automotive Painting: One Two Three          
Auto Body: One Two Three          
Gas Engine Mechanic: One Two Three          
Diesel Mechanic: One Two Three          
Hydraulic Plumbing: One Two Three          
Pneumatic Plumbing: One Two Three          
Hydraulic Pump Rebuilding: One Two Three          
Hydraulic Cylinder Rebuilding: One Two Three          
Hydraulic Valve Rebuilding: One Two Three          
Hydraulic Hose Assembly: One Two Three          
Air Compressor Rebuilding: One Two Three          
Air Compressor Plumbing: One Two Three          
PTO Installation: One Two Three          
Forklift: One Two Three          
JIB Hoist: One Two Three          
Bridge Crane: One Two Three          
Shipping and Receiving: One Two Three          
Copy Machine: One Two Three          
Fax: One Two Three          
Computer: One Two Three          
Filing: One Two Three          
List any special skills that you have:
Please read carefully
Applicant's certification and agreement
I hereby certify that the facts and information set forth by me in the above employment application are true and complete to the best of my knowledge. I understand that if employed, falsified statements, misrepresentations or ommisions on this application shall be considered sufficient cause for dismissal.
      
Initial: Date: