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Phone: 253-250-0860
info@mercerlogistics.com

General Warehouse Application

    Instructions to applicant: Please answer all questions. If the answer to any question is "no" or "none", do not leave it blank, write "no" or "none" in the space.

    First Name
    Last Name

        ext.

          ext.

            ext.

                                          Current and Three Years Previous Addresses

                                            Street
                                            Apt# / PO Box
                                            City
                                            StatePostal Code

                                              Street
                                              Apt# / PO Box
                                              City
                                              StatePostal Code

                                                Street
                                                Apt# / PO Box
                                                City
                                                StatePostal Code

                                                  Street
                                                  Apt# / PO Box
                                                  City
                                                  StatePostal Code

                                                    Education

                                                    Please circle the highest grade completed

                                                            Work History

                                                            Give a complete work history for the past THREE years, including any unemployment or self-employment and provide W-2 or 1099, for any out of business companies. Begin with the most recent job.

                                                              Last Employment

                                                                      Street
                                                                      Apt# / PO Box
                                                                      City
                                                                      StatePostal Code

                                                                        ext.

                                                                              Previous Employment 1

                                                                                      Street
                                                                                      Apt# / PO Box
                                                                                      City
                                                                                      StatePostal Code

                                                                                        ext.

                                                                                              Previous Employment 2

                                                                                                      Street
                                                                                                      Apt# / PO Box
                                                                                                      City
                                                                                                      StatePostal Code

                                                                                                        ext.

                                                                                                              Previous Employment 3

                                                                                                                      Street
                                                                                                                      Apt# / PO Box
                                                                                                                      City
                                                                                                                      StatePostal Code

                                                                                                                        ext.

                                                                                                                              Previous Employment 4

                                                                                                                                      Street
                                                                                                                                      Apt# / PO Box
                                                                                                                                      City
                                                                                                                                      StatePostal Code

                                                                                                                                        ext.

                                                                                                                                              Previous Employment 5

                                                                                                                                                      Street
                                                                                                                                                      Apt# / PO Box
                                                                                                                                                      City
                                                                                                                                                      StatePostal Code

                                                                                                                                                        ext.

                                                                                                                                                              Personal References

                                                                                                                                                              List three persons for references, other than family members who have knowledge of your safety habits

                                                                                                                                                                First Name
                                                                                                                                                                Last Name

                                                                                                                                                                  ext.

                                                                                                                                                                    First Name
                                                                                                                                                                    Last Name

                                                                                                                                                                      ext.

                                                                                                                                                                        First Name
                                                                                                                                                                        Last Name

                                                                                                                                                                          ext.

                                                                                                                                                                            To be Read and Signed by Applicant

                                                                                                                                                                            I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquires of my personal, employment, educational, financial, or medical history and other related matters as may be necessary for an employment decision. I herby release employers, schools, or persons from all liability in responding to inquiries in connection with my application. In the event I am employed, I understand that false or misleading information given in my application interview may result in discharge.

                                                                                                                                                                              First Name
                                                                                                                                                                              Last Name

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