Fields marked with an asterisk (*) are required.
First Name *
Last Name *
Address *
City *
State *
Zip *
E-mail Address *
Phone Number *
Date Available *
Desired Pay *
Position Applied For *
Hours Per Week Available *
Are you interested in working in-house at PQS? * Yes No
Are you a citizen of the United States? * Yes No
If no, are you authorized to work in the U.S.?* Yes No
Have you ever contracted with this company? * Yes No
If yes, when? *
Were you referred by someone to apply? * Yes No
If yes, who? *
Do you have any physical limitations that pertain to the job duties as listed in the job description? * Yes No
If Yes, list?*
Please list three professional or personal references.
Full Name *
Relationship *
Company *
Phone *
List below last three employers, starting with last one first.
Supervisor *
Responsibilities *
From *
To *
Reason for Leaving *
May we contact your previous supervisor for a reference? * Yes No
Branch*
From*
To*
Rank at Discharge*
Type of Discharge *
I certify that my answers are true and complete to the best of my knowledge. If this application leads to parts assembly, I understand that false or misleading information in my application or interview may result in my release.
Signature *