Corporate Headquarters
1601 Pike Avenue Effingham, IL 62401
Which Koerner Location are you applying for? * EffinghamChampaignNew BadenCarterville
Position Name: *
Today's Date: *
First Name: *
Middle Name: *
Last Name: *
Street Address: *
City: *
State: *
Zip: *
Phone Number: *
Email Address: *
Are you 18 years of age or older? * YesNo
Are you legally eligible for employment in the USA? * YesNo
Do you have a CDL? * YesNo
Position Applying For:
Were you recommended to apply? YesNo
If yes, by whom?
Rate of Pay Expected:
Hours: Full TimePart Time
Specify days and hours, if part-time:
Ex.: Available Monday through Friday from 8:00 am until 1:30 pm.
Are you willing to work any shift available? YesNo
Shift Preferences:
Please list your shift preferences and any other information pertinent to your availability.
Are you willing to work additional hours, as necessary? YesNo
Were you previously employed by us? YesNo
If yes, when?
If hired, on what date will you be available to start work?
Related Skills, Experiences or Qualifications:
College:
Name and Location of College Attended
Number of Years Attended: 1234
Did you graduate? YesNo
Comments:
High School:
Most Recent Previous Employer
Past Employment #1: *
Business Location: *
Start Date: *
Separation Date:
Job Duties: *
Name of Supervisor: *
Reason for Leaving:
Past Employment #2:
Business Location:
Start Date:
Job Duties:
Name of Supervisor:
Past Employment #3:
Past Employment #4:
Have you ever served in the US Armed Forces? * YesNo
If yes, what branch?
Enlistment Date:
Rank at Discharge:
List of Military Duties and Special Training:
Please No Former Employers or Relatives.
Personal Reference: *
City, State: *
Personal Reference:
City, State:
Phone Number:
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