Employment Application Name* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Are you 18 years old or older?*--YesNoAre you legally eligible for employment in the United States?*--YesNoDo you use tobacco products?*--YesNoHave you ever been convicted of a felony?*--YesNoIf yes, when?*Employment InformationPreferred Shift*--2nd (3:00pm - 11:20pm)3rd (11:00pm - 7:20am)Availability*--Full TimePart TimeSummer/TempPreferred location*--Clinton, IADeWitt, IAWalnut Ridge, ARPosition*--Manufacturing Team Member / Machine OperatorOther (please specify)Other PositionAre you employed now?*--YesNoHow much notice do you need to give?*Have you ever worked at Custom-Pak?*--YesNoIf yes, when?*Education HistoryHigh School / GED*Did you graduate high school or get your GED?*--YesNoCollegeDid you graduate college?--YesNoBusiness / Trade SchoolDid you graduate from business or trade school?--YesNoEmployment HistoryCurrent Employer*Current Position*Start Date*End Date*Reason for leaving*Still employed?*--YesNoDo you need to enter another employer?YesNoPast EmployerPosition heldStart DateEnd DateReason for leavingDo you need to enter another employer?YesNoPast EmployerPosition heldStart DateEnd DateReason for leavingDo you need to enter another employer?YesNoPast EmployerPosition heldStart DateEnd DateReason for leavingDo you need to enter another employer?YesNoPast EmployerPosition heldStart DateEnd DateReason for leavingDo you need to enter another employer?YesNoPast EmployerPosition heldStart DateEnd DateReason for leavingAttach your resume as a PDF fileAccepted file types: pdf.All facts contained in this application must be true and complete. If you are hired by Custom-Pak, falsified information or statements, or deliberate omissions will result in immediate termination.How did you hear about Custom-Pak?*e.g. Advertisement (online, billboard, newspaper), friend or family recommended, etc.I accept the terms of service Yes