Employment Application Name* First Middle Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Are you 18 years old or older?*--YesNoAre you legally eligible for employment in the United States?*--YesNoDo you use tobacco products?*--YesNoHave you ever been convicted of a felony?*--YesNoIf yes, when?* Employment InformationPreferred Shift*--2nd (3:00pm - 11:20pm)3rd (11:00pm - 7:20am)1st DEWITT IOWA ONLY (7a-3:20p)Availability*--Full TimePart TimeSummer/TempPreferred location*--Clinton, IADeWitt, IAWalnut Ridge, ARPosition*--Manufacturing Team Member / Machine OperatorOther (please specify)Other Position Are you employed now?*--YesNoHow much notice do you need to give?* Have you ever worked at Custom-Pak?*--YesNoIf yes, when?* Education HistoryHigh School / GED* Did you graduate high school or get your GED?*--YesNoCollege Did you graduate college?--YesNoBusiness / Trade School Did you graduate from business or trade school?--YesNoEmployment HistoryCurrent Employer* Current Position* Start Date* End Date* Reason for leaving* Still employed?*--YesNoDo you need to enter another employer? Yes No Past Employer Position held Start Date End Date Reason for leaving Do you need to enter another employer? Yes No Past Employer Position held Start Date End Date Reason for leaving Do you need to enter another employer? Yes No Past Employer Position held Start Date End Date Reason for leaving Do you need to enter another employer? Yes No Past Employer Position held Start Date End Date Reason for leaving Do you need to enter another employer? Yes No Past Employer Position held Start Date End Date Reason for leaving Attach your resume as a PDF fileAccepted file types: pdf, Max. file size: 2 MB.All facts contained in this application must be true and complete. If you are hired by Custom-Pak, falsified information or statements, or deliberate omissions will result in immediate termination.How did you hear about Custom-Pak?* e.g. Advertisement (online, billboard, newspaper), friend or family recommended, etc.I accept the terms of service Yes captcha
