Demographic Information
Date of Application*:
How where you referred to us?*
Name*:
Street Address*:
City* : State*:
New York
Alaska
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Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
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Hawaii
Iowa
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Zip Code*:
Email Address*:
Phone Number*:
Home
Work
Cell
Phone Number 2 :
Home
Work
Cell
Employment Data
Date Available to Start*:
Social Security Number*:
Salary Requirment*:
If you are under 18 and we require a work permit, can you furnish one?*
Yes
No
If no, please explain:
Have you ever worked for Ideal PMT Machine?*
Yes
No
If yes, when?
Are you a citizen of the United States?*
Yes
No
If not, are you legally allowed to work in the United States?
Yes
No
Type of employment desired? (Full Time, Part Time, Seasonal)*
Have you ever pleaded "guilty", "no contest", or been convicted of a crime?*
Yes
No
If yes, please provide dates and details:
Answering "yes" to these questions does not constitutue an automatic rejection for employment. Date of the offense, seriouslness and nature of the violation, rehabilitation, and postion applied for will be considered.
Driver's license number*:
State of Isssue*:
New York
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Please summarize your special skills or qualifications*:
Previous Employement History
Job 1
Dates of Employement: From:
To:
Position:
Company:
Street Address:
City:
State:
New York
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip Code:
Supervisor Name:
Supervisor Title:
Phone Number:
Home
Work
Cell
Starting Title:
Starting Salary:
Ending Title:
Ending Salary:
Reason for Leaving:
Job 2
Dates of Employement: From:
To:
Position:
Company:
Street Address:
City:
State:
New York
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip Code:
Supervisor Name:
Supervisor Title:
Phone Number:
Home
Work
Cell
Starting Title:
Starting Salary:
Ending Title:
Ending Salary:
Reason for Leaving:
Job 3
Dates of Employement: From:
To:
Position:
Company:
Street Address:
City:
State:
New York
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip Code:
Supervisor Name:
Supervisor Title:
Phone Number:
Home
Work
Cell
Starting Title:
Starting Salary:
Ending Title:
Ending Salary:
Reason for Leaving:
By submitting the information below the applicant attests that they are able to legally seek employment in the United States and the following certifications:
Ideal PMT Machine is an equal opportunity employer and promotes non-discriminatory practices and procedures in all phases of its operations and prohibits any form of unlawful discrimination and other considerations made unlawful by federal or state laws including race, does not discriminate in employment and activities on the basis of race, national origin, color, creed, religion, sex, age, disability, veteran status, sexual orientation, gender identity, or associational preference. Non-discrimination does not guarantee an employee or member of the public any rights not otherwise provided by law.
By the applicant entering their name in the box below, they are electronically signing this application and it carries the same legal value as if it were signed by the applicant in person.