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Available Positions:

Screen Print Operator

Sidney, OH

Personal Data

Name:(Required)

First Last

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone:(Required)

Alternate Phone:

Email Address(Required)

Job Interest

Desired Position:(Required)

Desired Shift:(Required)

Full Time

Part Time

Intern

Desired Start Date:(Required)

Month

Day

Year

How did you hear about us?

Employee Name:

The employee who told you about the opportunity.

Have you ever been employed by Riverside Mfg., LLC before?(Required)

Yes

No

If yes, when & in what position:

Are you a US Person? (US Citizen, US Permanent Resident or Refugee/Asylum Seeker)?(Required)

Yes

No

Are you at least 18 years of age?(Required)

Yes

No

Have you ever been discharged or asked to resign by an employer?(Required)

Yes

No

If yes, please explain:

Have you ever been convicted of a felony?(Required)

Yes

No

If yes, please explain:

( A positive response will not necessarily disqualify an applicant from employment. )

Education

High School/GED

Name & Location:

Areas of Study:

Graduated?

Yes

No

Enrolled

College/University

Name & Location:

Areas of Study:

Graduated?

Yes

No

Enrolled

Business, Trade, Technical

Name & Location:

Areas of Study:

Graduated?

Yes

No

Enrolled

Other

Name & Location:

Areas of Study:

Graduated?

Yes

No

Enrolled

Employment History

( Please provide a complete record of your employment history beginning with your present or most recent position. )

Company Name:

Business Type:

Address:

Supervisor:

Supervisor Title:

Position:

Shift:

Full Time

Part Time

Temporary

Start of Employment:

Month

Day

Year

End of Employment:

Month

Day

Year

Ending Salary:

Numeric Value Only

Reason for Leaving:

May we contact?

Yes

No

Description of Duties:

Company Name:

Buisness Type:

Address:

Supervisor:

Supervisor Title:

Position Title:

Shift:

Full Time

Part Time

Temporary

Start of Employment:

Month

Day

Year

End of Employment:

Month

Day

Year

Ending Salary:

Numeric Value Only

Reason for Leaving:

May we Contact?

Yes

No

Description of Duties:

Company Name:

Business Type:

Address:

Supervisor:

Supervisor Title:

Position Title:

Shift:

Full Time

Part Time

Temporary

Start of Employment:

Month

Day

Year

End of Employment:

Month

Day

Year

Ending Salary:

Numeric Value Only

Reason for Leaving:

May we contact?

Yes

No

Description of Duties:

Professional References

Please list up to 3 professional references(Required)

Name

Company & Title

Telephone #

Comments

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Riverside mfg, LLC.

14510 Lima Rd
Fort Wayne, Indiana, USA

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