GCQA: Gibson County Quality Assurance
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Application
Please fill out this application completely before submitting
Required Fields are Indicated in Red
Personal Information:
Last Name:
First Name:
Middle Name:
E-Mail Address:
Present Address:
Street:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
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Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Zip Code:
How Long?
Telephone:
Permanent Address:
Street:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Zip Code:
How Long?
Telephone:
Other Personal Information You Wish To Provide:
Are you 18 years or older?
Yes
No
Are you presently employed?
Yes
No
Have you previously been employed by Total Interior Systems America (TISA), Excell, or Fia?
Yes
No
Have you been employed by any temporary agency working inside the TISA, Excell, or Fia Plant?
Yes
No
Position Information:
Position Desired:
Shift:
1st
2nd
Date Available for Work:
Satisfactory Monthly Earnings:
Education:
High School
Name:
Location:
Diploma:
GPA:
College
Name:
Location:
Degree:
Major:
GPA:
Graduate/Other
Name:
Location:
Degree:
Major:
GPA:
School Activities, Honors, Awards, and Offices Held:
Are you continuing your studies?
Yes
No
If yes, where?
Military:
Military Experience US Armed Forces?
Yes
No
Branch of Service:
Date Entered:
Date Discharged:
Time on Active Duty:
Final Rank or Rating:
Draft Classification:
Member Active Reserve:
Primary Job in The Military:
Special Schools Attended:
Skills:
Factory Positions:
List factory machinery or equipment and factory skills in which you are experienced:
Office and Clerical Positions:
Type:
Yes
No WPM:
Short Hand:
Yes
No WPM:
List other office equipment skills in which you are experienced:
References:
Reference 1:
Name:
Address:
City, State, Zip:
Phone Number:
Occupation:
Years Known:
Reference 2:
Name:
Address:
City, State, Zip:
Phone Number:
Occupation:
Years Known:
Reference 3:
Name:
Address:
City, State, Zip:
Phone Number:
Occupation:
Years Known:
Employment History:
Most Recent Employer:
Name:
Address:
City, State, Zip:
From (M/Y):
To (M/Y):
Supervisor:
Job Title:
Describe Major Duties:
Reason for Leaving:
Employer:
Name:
Address:
City, State, Zip:
From (M/Y):
To (M/Y):
Supervisor:
Job Title:
Describe Major Duties:
Reason for Leaving:
Employer:
Name:
Address:
City, State, Zip:
From (M/Y):
To (M/Y):
Supervisor:
Job Title:
Describe Major Duties:
Reason for Leaving:
Miscellaneous:
If currently employed, may we contact your present employer(s)?
Yes
No
Have you been convicted of a felony in the past 10 years?
Yes
No
If yes, what class of felony did you receive?
In Case of Emergency, Notify:
Name:
Relationship:
Phone Number:
Submit