Careers Apply Now Miller Industrial Manufacturing is an equal opportunity employer and we welcome applications from qualified potential employees. We are proud to offer a comprehensive benefits package including: Competitive Salaries 401(k) Match Fully Paid Health Insurance Vision and Dental Insurance Profit Sharing Paid Vacation JOB APPLICATION Employment Application Section-1: Applicant Information Full Name * Full Name First First Middle Middle Last Last Email Address * How long have you lived at this address? * Phone If under 18, please list your age Desired salary (range) * Can you work nights? * Yes No Employment desired Full time Part time When available to start work? Have you ever been convicted of a crime? * Yes No What is your means of transportation to work? * Do you have a valid driver's license? * Yes No Expiration date: Have you had any accidents during the past three years (If yes, how many)? * Section-2: Applicant Education (High School) Name of High School Address of High School Attended (From): Attended (To): Did you graduate (High School)? Yes No Diploma (High School) Section-3: Applicant Education (college) Name of College College address Attended (From): Attended (To): Did you graduate (college)? Yes No Major and Degree (College) Section-4 Education (Other) Name of (Other): Address (Other): Attended (From): Attended (To): Major and Degree (Other) Did you graduate (Other)? Yes No Please list three references Reference #1 Name * Name First First Last Last Relationship Phone Email Company/Organization Address Reference #2 Name Name First First Last Last Relationship Phone Email Company/Organization Address Reference #3 Name Name First First Last Last Relationship Phone Email Company/Organization Address Section-5 Work Experience Please list your three most recent places of employment (Company-A) Company * Phone * Supervisor * Supervisor First First Last Last Address * Job Title Starting Salary ($) Ending Salary ($) Responsibilities From To Reason for leaving May we contact your previous supervisor for a reference? * Yes No (Company-B) Company * Phone * Supervisor * Supervisor First First Last Last Address * Job Title Starting Salary ($) Ending Salary ($) Responsibilities From To Reason for leaving May we contact your previous supervisor for a reference? * Yes No (Company-C) Company * Phone * Supervisor * Supervisor First First Last Last Address * Job Title Starting Salary ($) Ending Salary ($) Responsibilities From To Reason for leaving May we contact your previous supervisor for a reference? * Yes No Section-6 Military Have you ever been in the armed forces? * Yes No Are you now a member of the National Guard? * Yes No Specialty Discharge Date Section-7 Skills Other specialized training and skills Section-8 Emergency Contact In case of accident or illness, please contact: * In case of accident or illness, please contact: First First Last Last Daytime Phone * Relationship * Address * Section-9 Signature I certify that the statements made by me on this application are true and complete to the best of my knowledge and are made in good faith. I understand that if I knowingly make any misstatement of fact, I am subject to disqualification and dismissal and to such other penalties as may be prescribed by law or personnel regulations. All statements made on this application, including employment information, are subject to verification, as a condition of employment. Additional Information Did you complete this application yourself? * Yes No I certify... * I certify that my answers are true and complete to the best of my knowledge If you are human, leave this field blank. Submit
