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Colorado Railcar Manufacturing, LLC
Employment Application

First job choice:
 (Required)
Second job choice:
 (optional)
Third job choice:
 (optional)

Personal Information:
First Name:
 Middle Initial Last Name:
Home Phone With Area Code:
 Work Phone With Area Code:
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Current Address Line 1:
Current Address Line 2:
City State: Zip/Postal Code:
Country:
Prior Address Line 1:
Prior Address Line 2:
City: State: Zip/Postal Code:
E-mail Address:

Availability
Start date available:

Job Related Skills
Yes No If the job requires, do you have the appropriate valid drivers license?
Name on license:
License number:
State of Issue:
Please list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or company
Yes No Have you fully read the job description for this position?
Yes No Do you understand these essential functions?
Yes No Can you perform the essential functions of this job with or without reasonable accommodation?
List languages in which you are fluent



Previous Employers:

 PLEASE NOTE. Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. FOR EMPLOYERS OUTSIDE THE U.S., A CURRENT FAX NUMBER IS MANDATORY.


Most Recent Employer
Yes
No
 Are you currently working for this employer?
Yes
No
 If yes, may we contact?
Phone:
Fax:
Company Name: City: State:
Date Employed: Job Title: Supervisor Name
to
Duties:
Salary: Reason for Leaving:
$ per

Second Most Recent Employer
Phone:
Fax:
Company Name: City: State:
Date Employed: Job Title: Supervisor Name
to
Duties:
Salary: Reason for Leaving:
$ per

Third Most Recent Employer
Phone:
Fax:
Company Name: City: State:
Date Employed: Job Title: Supervisor Name
to
Duties:
Salary: Reason for Leaving:
$ per

References  Include only individuals familiar with your work ability. Do not include relatives.
Name Address Phone Years Known Relationship

Education  Note: Do not fill out any part of this section you believe to be non job-related.
Please select the highest grade completed:
If your school records are under a different name than listed above, please enter that name:
Name City State Graduated? Degree:
(High School)
(College)
(Other)

 

AFFIRMATIVE ACTION QUESTIONNAIRE
This information is being gathered for affirmative action under Section 503 of the Rehabilitation Act of 1973. The information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire.

The purpose of this section is to assist in monitoring Affirmative Action Programs and to aid in complying with any required Government record keeping or periodic reporting. This information is not part of your employment application, and will not be considered in the employment/selection process. If you choose to provide the information, please complete the following:
Race: (check one)        
White - origins in Europe, North Africa, or Middle East
Asian - origins in Far East, S.E. Asia, India or Pacific Islands
Black - origins in Africa

Hispanic - Mexican, Puerto Rican, Cuban, Central or South America

American Indian - origins in North America, to exclude Alaska


Physical Condition:        
No Handicap
Physically Handicapped (No Facility Modification)
Physically Handicapped (Facility Modification)

Health Handicapped (Heart Attack, Diabetic, Seizures, etc.)

Mentally Handicapped (Learning Disabled)


Sex: Male Female

Veterans/U.S. Military status:        
Non-Veteran
Pre-Vietnam Veteran
Pre-Vietnam Veteran with service incurred disability

Vietnam Era Veteran (8/5/64 - 5/7/75)

Vietnam Era Veteran with service incurred disability

Post Vietnam Veteran

Post Vietnam Veteran with service incurred disability


Active National guard reservist (check one) Yes No


Please provide any other information about yourself that we should consider:



 

Colorado Railcar Manufacturing, LLC | (303) 857-1066 | E-mail: Sales | Engineering | Administration