Name.................. .

Address................

City.........................

State, Zip...............

Country...................

Phone.....................

E-mail.....................

Position Desired..

Date Available .. ..

Are you at least 18 years old?.......... .Yes.................. ....No

Are there any hours or days of the week you cannot work?......... .Yes.................. ....No

If so, when?............

Salary Desired.......

Select any of the following options that apply to the shift you desire

First Shift Full Time..... Second Shift Full Time ..... Third Shift Full Time

First Shift Part Time..... Second Shift Part Time ..... Third Shift Part Time

How did you hear about Mansfield Screw Machine Products? Choose one of the following options:

Personal Reference Newspaper Ad Temporary Agency Other

Have you ever been convicted of a felony, which has not been annulled, expunged, or sealed by the court? (A "yes" answer will not automatically disqualify you.

If yes, please explain conviction; where, when and disposition

Have you previously been employed by Mansfield Screw Machine Products?......... .Yes.................. ....No

If yes, when and under what name?

Choose last grade completed in school:

Grade School (1st-7th grade) 8th 9th 10th 11th 12th

Did you receive your:

Diploma GED Neither

High School Attended.

List schools attended other than High School. Include city, state, courses studied.

Are you now, or have you ever been a member of the Armed Forces of the United States?......... .Yes.................. ....No

Branch...........................

Date Entered................

Date Discharged.........

Rank at Discharge......

Reserve Status...........

Special Training Received.

List, beginning with the most recent, all present and past employment, including Employer phone number, dates employed, and the position you held. Also, explain the reason you left employment, salary, and brief description of duties.

Please provide the name, address and phone number of three persons not related to you.

Please provide the name/address/phone number in case of emergency?

Please read and answer appropriately that you agree or disagree.

I understand that, prior to being offered employment, I may be requested to take an employment 
examination. In the event that I have a disability that will affect my ability to take the test, I will so inform 
TMP prior to the administration of the test so that a reasonable accommodation can be made. The 
Company reserves the right to require medical documentation regarding the need for accomodation.
......... .Agree.................. ....Disagree
 
I certify 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 may result in termination.
......... .Agree.................. ....Disagree
 
I understand that, if hired, my employment is for no definite period and may, regardless of the date of 
payment of my wages and salary, be terminated with or without cause, at any time, with or without notice.
......... .Agree.................. ....Disagree
 
I authorize investigation of all statements contained in this application for any employment-related purpose. 
I release the listed references and all employers, to provide you with all applicable information they 
may have. I hereby release these references and former employers from all liability for any information 
they may give to you.
......... .Agree.................. ....Disagree
 
I understand that The Immigrant Reform & Control Act of 1986 states that employers must require 
all persons hired to submit documents to the employer showing their identity and their rights to be 
lawfully employed in the United States.  It also requires that the employee complete and sign a 
government form to this effect.
......... .Agree.................. ....Disagree
 
I understand that if hired by Mansfield Screw Machine Products, I will need to furnish documents for inspection that 
verify my identity and indicate I am legally permitted to work in the United States. Acceptable documents 
include your driver's license or State issued ID, and Social Security Card or Birth Certificate.
......... .Agree.................. ....Disagree
 
I understand that these documents must be provided within three (3) working days of employment. If the 
original documents are not available, I must submit proof that I have applied for the required documents.
......... .Agree.................. ....Disagree

Application date...........

Enter your full name in the space provided below if you agree to the above statements.

........................................