Employment Application

Are you 18 years or older? 
Please Indicate the shift(s) that you are available to work*:
First Shift: Monday - Thursday 4:00 am - 2:30 pm
Second Shift: Monday - Thursday 2:15 pm - 12:45 am
Weekend Shift: Friday - Sunday 6:00 am - 6:30 pm
*Shifts listed are subject to change
Are you employed now?  If yes may we inquire of your present employer? 
Have you ever worked for Jay Manufacturing before? 
Type of School Name, City, State Years Completed Major or Degree
High School
Technical College
Military Service 
Employment History
List below your last three employers starting with the most recent.
Dates of Employment:
Dates of Employment:
Dates of Employment:
Please list three persons you are not related to, whom you have known at least one year.
Name Address Company Phone Number
Are you currently legally authorized to work in the United States? 
Have you ever been convicted of a crime (other than a minor traffic violation), or do you have such a charge pending? 
Please complete this section only if you are applying for a truck driver position.
Do you have a valid WI CDL? 
Have you had any accidents or moving violations in the past 3 years? 

MY SIGNATURE BELOW CERTIFIES that the above information and any attachments are true and accurate to the best of my knowledge. If employed by Jay Manufacturing Oshkosh, Inc, I understand that any misrepresentation of factual information contained herein may be cause for dismissal.
MY SIGNATURE BELOW AUTHORIZES Jay Manufacturing Oshkosh, Inc to process my application for employment by checking references with former employers, schools, individuals and law enforcement agencies. I authorize the references and employers listed above to give Jay Manufacturing any and all information concerning my employment and any pertinent information they may have, personal or otherwise.
MY SIGNATURE BELOW RELEASES Jay Manufacturing Oshkosh, Inc its employees and representatives, from all liability for any damage whatsoever incurred in obtaining information from references or in further disseminating such information.
MY SIGNATURE BELOW CERTIFIES that I understand that any offer of employment with Jay Manufacturing Oshkosh, Inc, is contingent upon taking and passing a pre-employment drug screen.