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MWL EMPLOYEE APPLICATION

Please complete the application form below and submit it to the Midwest Labor Office closest to you.

After you've submitted this application, WE WILL CONTACT YOU and schedule a time when you can come to our office and meet with us. PLEASE DO NOT COME IN WITHOUT A SET APPOINTMENT. We are not able to meet with you without an appointment. When we ask you to come to our office, you will need to bring a valid photo ID, Social Security card or Birth Certificate (to verify US Citizenship) and these completed forms: IRS Form W-4, IRS Form W-5, and this INS Employability Eligibility Verification form. Without your ID and these forms, we may not be able to set you up as an employee. Questions? Please contact your nearest office.

As always, you can take comfort in knowing that all the information you submit to Midwest Labor is kept strictly confidential.


* Indicates required fields.
APPLICATION FOR EMPLOYMENT
* Last name * First name Middle
* Street
* City * State * Zip
* Day phone Evening phone
* Social security number * Email
 
* Closest MWL Office:
 
* Are you 18 years or older?    
* Date of birth
* Do you have transportation?    
 
* Please check the days you are available for work:
                 
 
* Please check shift preference(s).        
 
* Please check appropriate box(es):     
 
* How many hours per week?  
***Note: A reasonable effort will be made to accommodate religious beliefs or practices.
 
* Is there any known reason applicant would not be able to perform certain job duties?     
If "Yes", please describe so Midwest Labor may accommodate applicant's specific needs.
 
* Have you ever been convicted of a crime?     
If "Yes", please describe.
***Note: A conviction will not necessarily disqualify applicant from employment with Midwest Labor.
PLEASE LIST 3 CURRENT PERSONAL OR WORK REFERENCES THAT WE MAY CONTACT
Reference #1
* Last name * First name
* City * State
* Day phone * Relationship
 
Reference #2
* Last name * First name
* City * State
* Day phone * Relationship
 
Reference #3
* Last name * First name
* City * State
* Day phone * Relationship
WORK HISTORY
Please be as specific as possible.
Employer #1
* Company name * Day phone
* Street
* City * State * Zip
* Name of supervisor * Type of business
* 
* Position held
* Employment begin * Employment end
* Start wage * End wage
* Duties:
 
* Reason(s) for leaving:
 
Employer #2
Company name Day phone
Street
City State Zip
Name of supervisor Type of business
Position held
Employment begin Employment end
Start wage End wage
Duties:
 
Reason(s) for leaving:
 
Employer #3
Company name Day phone
Street
City State Zip
Name of supervisor Type of business
Position held
Employment begin Employment end
Start wage End wage
Duties:
 
Reason(s) for leaving:
 
Employer #4
Company name Day phone
Street
City State Zip
Name of supervisor Type of business
Position held
Employment begin Employment end
Start wage End wage
Duties:
 
Reason(s) for leaving:
* Have you ever worked for an employment agency before?     
If "Yes", what agencies did you work for?
 
What companies were you sent to work at, rate of pay, supervisor's name(s), etc.
OTHER EXPERIENCES
HOTEL WORK
Position Experience
Housekeeping   
Front Desk   
Lifeguard   
Reservation   
Maintenance   
Yard Work   
Pool Maintenance   
 
RESTAURANT
Position Experience
Busser   
Cook   
Hostess   
Dishwasher   
Wait Staff   
Bartender   
 
INDUSTRIAL
Position Experience
Assembly   
Inspector/Packer   
Material Handler   
Fork Lift Operator   
Machinist   
Janitorial   
Lumber Handlers   
 
RETAIL
Position Experience
Cashier   
Sales Experience   
Stock Handler   
 
SKILLED LABOR
Position Experience
Basic Construction   
Rough Carpentry   
Finished Carpentry   
Roofer   
Drywall   
Plasterer   
Electrician   
Welding   
Concrete Work   
Masonry   
Painting   
 
CLERICAL
Position Experience
Bookkeeping   
Secretary   
Data Entry   
Auditor   
Receptionist   
 
OTHER
Position Experience
  
  
  
ADDITIONAL INFORMATION
Management/Supervisor Experience
Type of business Experience
  
  
 
Factory Experience
Machines/Equipment Operated Experience
  
  
  
  
 
Construction Experience
Tools/Machines Operated Experience
  
  
  
  
 
Special Skills - Construction Experience
  
  
 
Office Experience
Please include both computer & office duties. Experience
  
  
  
  
 
Please list any other education, certifications, licenses, etc. you have that would help with job placement:
AUTHORIZATION
I certify by checking the box marked "Yes" and by entering my name below that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references employers listed within to give Midwest Labor any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.

* I have read and agree with the above authorization and application terms. 
 
* Applicant Full Name
* Image Verification
Please enter the text from the image.
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