Picture   • Sandblasting
• Painting
• Roofing
• Concrete Repair 		• Lead Testing & Encapsulation
• Fully Insured
• Mobile
• Experienced
• Sign Design and Painting
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Home Services Service Form Job Opportunities
                 

Job Application Form

Fax:1-605-787-7449 or Mail to:P.O.Box 582, Blackhawk, SD 57718
Fill out the form and then print it out and either fax or mail it to us!

Section 1- Personal Information

Last:

First:

Middle:

Soc. Security No:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Extension:

E-mail Address:

What date are you available for employment?

Have you been convicted of/or plead guilty to a criminal activity?

 Yes

 No

If yes, give details including dates:

Section 2-Employment History Information

Please provide the following information starting with your most recent employer.

1.

May we contact this employer:

 Yes

 No

Employer:

Your Title:

Employed From:

To:

Street Address:

City:

State:

Zip:

Work Phone:

Extension:

Immediate Supervisor:

Reason For Leaving:

Final Base Salary:

2.

May we contact this employer:

 Yes

 No

Employer:

Your Title:

Employed From:

To:

Street Address:

City:

State:

Zip:

Work Phone:

Extension:

Immediate Supervisor:

Reason For Leaving:

Final Base Salary:

Section 3-Technical Background

Please identify any of the following areas in which you have experience.  Fill in the boxes to give any specific details about each area of experience.

Years of Experience

Spray Painting:

Sandblasting:

Roofing:

Concrete Repair:

Sign Painting:

Section 4-Professional References

Please identify individuals familiar with your work related abilities and performance.

1.

Name:

Occupation:

Relationship:

Phone:

Extension:

2.

Name:

Occupation:

Relationship:

Phone:

Extension:

Section 5-Application Terms and Conditions

I hereby authorize verification of all information provided by me in this application and all information contained in my resume.  I understand and agree that if any misrepresentation or omission of the facts has been made by me, any offer of employment made by Midwest Paint Service Inc. may be terminated immediately without obligation or liability (other than payment for services actually rendered if I have been employed.)

Signature:

____________________________________________________

Date:

_________________________

Print and sign this form.
 
 
Midwest Paint Service, Inc.
Box 582 Blackhawk, SD 57718
Phone: 1-800-843-1995
Phone: 605-787-4764
Fax: 605-787-7449