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2411 US Route 22
Washington Court House
Ohio 43160
Phone: 740-333-1669
Fax: 740-333-7381
Serving Central and
Southern Ohio

Spring and Summer Hours:
Mon - Fri: 9 am to 5 pm
Sat: 9 am to 3:00 pm
Only applications completed in full will be considered for employment. Any follow up calls or visits to check on the status of your application will disqualify you as a potential candidate for employment. Once your application is reviewed, someone will contact you.
Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, creed, color, national origin, religion, age, sex, handicap, veteran status, marital status, sexual orientation, or any other characteristic protected by law. We are equal opportunity employer.
First Name: Last Name:
Address:
City: State:
Zip: Phone:
E-mail:
Desired Position:
SS# Date Of Birth:
 
Attach resume:
 
Drivers License #:
Do you have a valid Ohio Drivers License? Yes No Have you ever had a bond rejected? Yes No

Employment History
Please list chronologically, beginning with most recent experience.
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Employer: Address/City:
From (MM/YYYY): To (MM/YYYY):
Supervisor: Phone:
Salary:
Type of Work:
Reason for Leaving:
 
Education
Name & Location of School Select Last Year Completed Major Course Diploma/Degree
High School
College/University
College/University
Business or Trade School
 
Personal Information
Member of the Drug-Free Workplace Network. Pre-Employment Drug Testing is a Requirement.
Are you legally authorized to work in the U.S.?
(If hired, you will be required to provide proof of work authorization.) 		Yes No
Have you ever worked for us before?: Yes No
Have you ever applied to work here before?: Yes No
Are you at least 18 years of age?: Yes No
Briefly describe skills you may have that you acquired in other employment or armed forces:
Have you ever been convicted of a crime (felony)?: Yes No
If yes, give details:
(Convictions are not automatic bar to employment)
In order to check work records should we be informed of any name changes:
If you are experienced operator of any plant machines or equipment, please list:
Do you have any other skills you wish to mention?:
Are you presently employed?: Yes No
If so, may we contact your present employer?: Yes No
Have you ever been dismissed or forced to resign from a position? Yes No
If hired, when would you be available?:
What is your desired salary?:
 
Employment References
List individuals familiar with your job qualifications.
1) Name of Reference: 2) Name of Reference:
Occupation: Occupation:
Address: Address:
City/State/Zip: City/State/Zip:
Phone: Phone:
Relationship: Relationship:
How long known: How long known:
 
3) Name of Reference: 4) Name of Reference:
Occupation: Occupation:
Address: Address:
City/State/Zip: City/State/Zip:
Phone: Phone:
Relationship: Relationship:
How long known: How long known:
 
 

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Check this box to certify that you have read and accept the above statement.