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General Assembly & Production Quality Inspector Electronics Technician JOB APPLICATION PERSONAL DATA Name:(Required) First Last Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Home Phone:(Required) Alternate Phone: JOB INTEREST Desired Position:(Required) General Assembly & Production Quality Inspector Electronics Technician Desired Shift:(Required) Full Time Part Time Intern Desired Start Date:(Required) Month Day Year How did you hear about us? Select a Choice Employee Referral Indeed.com Billboard Advertisement Other Have you ever been employed by Riverside Mfg., LLC before?(Required) Yes No If yes, when & in what position: Are you legally permitted to work in this country?(Required) Yes No Are you at least 18 years of age?(Required) Yes No Have you ever been discharged or asked to resign by an employer?(Required) Yes No If yes, please explain: Have you ever been convicted of a felony?(Required) Yes No If yes, please explain: ( A positive response will not necessarily disqualify an applicant from employment. ) EDUCATION High School/GED Name & Location: Areas of Study: Graduated? Yes No Enrolled College/University Name & Location: Areas of Study: Graduated? Yes No Enrolled Business, Trade, Technical Name & Location: Areas of Study: Graduated? Yes No Enrolled Other Name & Location: Areas of Study: Graduated? Yes No Enrolled EMPLOYMENT HISTORY ( Please provide a complete record of your employment history beginning with your present or most recent position. ) Company Name: Business Type: Address: Supervisor: Supervisor Title: Position: Shift: Full Time Part Time Temporary Start of Employment: Month Day Year End of Employment: Month Day Year Ending Salary: Reason for Leaving: May we contact? Yes No Description of Duties: Company Name: Buisness Type: Address: Supervisor: Supervisor Title: Position Title: Shift: Full Time Part Time Temporary Start of Employment: Month Day Year End of Employment: Month Day Year Ending Salary: Reason for Leaving: May we Contact? Yes No Description of Duties: Company Name: Business Type: Address: Supervisor: Supervisor Title: Position Title: Shift: Full Time Part Time Temporary Start of Employment: Month Day Year End of Employment: Month Day Year Ending Salary: Reason for Leaving: May we contact? Yes No Description of Duties: PROFESSIONAL REFERENCES Please list up to 3 professional references(Required) Name Company & Title Telephone # Add © 2021 Riverside Mfg., LLC. All rights reserved worldwide. Privacy Policy