© 2006 Molding Systems Corp. All rights reserved.
126 North West Street Olney, IL 62450 Ph: 618-395-3888 Fax: 618-392-8050
Molding Services of Illinois
126 North West Street
Olney, Illinois 62450
Phone: 618-395-3888
Fax: 618-392-8050
www.moldingsystemscorp.com
Last Name * 
MOLDING SERVICES OF ILLINOIS - JOB APPLICATION FORM
Personal Information (Fields marked with an * are required.)
First Name *
Maiden Name
Middle Name *
Present Street Address *
City *
State *
Zip * Code
Phone *
Are you 18 yrs of age or older? *
Email address
Have you ever been
convicted of a
felony?
If yes, please
expain
Employment Desired
Position *
Date you can start
If so, may we inquire of your present employer?*
If yes, when?
(month/year)
Are you legally eligible for employment in the United States? *
Minimum salary you will accept?
Are you employed now? *
Ever applied to this company before? *
How or by whom were you referred to our company?
Are you available to work overtime?*
Are you available to work any shift?*
Education
High School
Dates Attended FromTo
FromTo(name, city and state)
Did you graduate?
Subjects studied
Subjects studied
College
(name, city and state)
Dates Attended FromTo
FromToDid you graduate?
Trade, Business
or Correspondence
(name, city and state)
Dates Attended FromTo
FromToDid you graduate?
Other
Subjects studied
(name, city and state)
Did you graduate?
Dates Attended FromTo
FromToTHE AGE DISCRIMINATION ACT OF 1967 PROHIBITS DISCRIMINATION ON THE BASIS OF AGE WITH RESPECT TO INDIVIDUALS WHO ARE AT LEAST 40 YEARS OF AGE.
Military (Complete this section if you served in the U.S. Armed Forces.)
Branch of Service
Period of Active Duty
From
To
(list month & year)
(list month & year)
Describe your
duties and any
special training
Rank at Discharge
Date of Final Discharge
Employment Experience (Start with your present or most recent employer)
(name, city and state)
1. Employer
Name and Tile of
Immediate
Supervisor
Position or job title
Salary
Telephone number
of Employer
Period employed
To
From
Reason for leaving
2. Employer
(name, city and state)
Name and Tile of
Immediate
Supervisor
Salary
Reason for leaving
Telephone number
of Employer
Position or job title
Period employed
From
To
3. Employer
(name, city and state)
Name and Tile of
Immediate
Supervisor
Salary
Reason for leaving
Telephone number
of Employer
Position or job title
Period employed
From
To
(name, city and state)
4. Employer
Position or job title
Telephone number
of Employer
Reason for leaving
Name and Title of
Immediate
Supervisor
Salary
Period employed
From
To
Personal References
1. Name
Relationship
Years Aquainted
Position
Relationship
2. Name
Position
Years Aquainted
List the names of three persons you are not related to and by whem you have NOT been employed.
1. Name
Occupation
City, State
Telephone
Years Aquainted
2. Name
Occupation
City, State
Telephone
Years Aquainted
3. Name
Occupation
City, State
Telephone
Years Aquainted
Thank you for your interest in employment at Molding Systems of Illinois. You will be contacted if your qualifications match our job criteria. Please ensure that the contact information you provide is accurate.
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