Online Job Application

Screen Machine Industries is an equal opportunity employer and does not discriminate against applicants or employees on the basis of sex, race, color, religion, national origin, ancestry, age, martial or veteran status, sexual orientation, or any other legally protected status. In addition Screen Machine Industries does not discriminate against qualified individuals with disabilities.

Personal Information

Last name

First name

Middle name





Zip code

How long have you lived at this address?

Phone number

Cell number

E-mail address

Birth month & day of month (ex: September 5th would be 09/05, please do not include year)

Are you related to anyone employed here? No / Yes
If the answer is yes then whom?

If formerly employed under a maiden or former name, what was it?

Were you referred to our company? No / Yes
If the answer is yes, then by whom?

Have you ever been convicted of a felony or misdemeanor? No / Yes
If the answer is yes, explain.

Employment Desired

What position are you applying for?

Are you over the age of 18? No / Yes

Are you legally authorized to work in the US? No / Yes

Are you currently employed? No / Yes If yes, may we contact your present employer? No / Yes

Are you willing to work overtime and on weekends when necessary? No / Yes
If the answer is no, explain.

Do you have adequate transportation to travel to and from work? No / Yes
If the answer is no, explain.

Have you ever applied to our company before? No / Yes
If the answer is yes, when?

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? No / Yes

Educational Experience

Please enter the name of the school(s) attended, the city, state and your GPA of that school(s), your graduation status and degrees/courses taken.

Education level Name of school Years attended Did you graduate? Subjects Studied & GPA
High school
Trade school

Please describe any additional skills, qualifications, training or awards:

References (3 minimum): Please provide their name, address, occupation and the number of years aquainted.

Former Employers

Start/End Dates
Name, address, phone of employer Salary Position Reason for leaving

Application Agreement

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

If you agree to the above statement then please type your name in the box below which will count as your electronic signature, by selecting the I Agree box you acknowledge further to this statement.

I agree to the above two statements Your Full Name

You can only upload doc, docx, pdf, txt, rtf or odt files.
If you have a resume please upload it here: