PDM Bridge LLC is an equal employment opportunity and affirmative action employer dedicated to a policy of non-discrimination in employment based upon an individual's race, color, creed, religion, age, gender, national origin, ancestry, veteran status, marital status, sexual orientation or the presence of any non-job-related medical condition or disability, or other characteristics protected by law. In reading and answering the following questions, please keep in mind that none of the questions are intended to imply any limitations, illegal preferences, or discrimination based upon any non-job-related information. This application will be given consideration, but its receipt does not imply that the applicant will be interviewed or employed. Click here for the PDM Bridge LLC employment terms or contact Human Resources if you need an accommodation to participate in the application process at (715) 835-2800 x2003.

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* Facility: 
* POSITION APPLIED FOR: 
* Date Available to Start Work: 
How were you referred to PDM Bridge?   Employee Referral    Former Employee Referal
 Newspaper   Job Service   Job Fair


* First Name: 
* Last Name: 
Middle Initial: 
 
* Address: 
* City: 
* State:  * Zip: 
 
Previous Address 1 Previous Address 2
Address: 
City: 
County: 
State:  Zip: 
Address: 
City: 
County: 
State:  Zip: 
 
 
*Day Phone:  *Evening Phone:  Cell: 
 
* Email: 
Resume: 
 
* Social Security #:  Drivers License #:  State Issued: 
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Have you ever applied for a job with this company in the past? If yes, please give the date of application and the position for which you applied. State your name at that time, if different from present name.   YES 
NO 
comments:

Have you ever been employed by this company in the past? If yes, please give dates of employment, position held, and state your name while employed if different from present name.   YES 
NO 
comments:

If hired, will you be able to work during the normal days and hours required for the position(s) for which you are applying? If no, please explain:   YES 
NO 
comments:
Do you have any commitments to another employer that might affect your availability for employment with our company? (i.e. on layoff)  If yes, please explain:   YES 
NO 
comments:
If hired, can you furnish proof that you are at least 18 years of age and that you are eligible to work in the United States? If no please explain:   YES 
NO 
comments:
Do you now, or will you in the future, require PDM Bridge LLC to sponsor an employment visa for your continued employment?   YES 
NO 
comments:
Have you been convicted of a felony or misdemeanor, or released from prison in the past 10 years? Note: A yes answer does not automatically disqualify you from employment since the nature of the offense, date, and type of job for which you are applying will be considered. If yes, please explain:   YES 
NO 
comments:
Are you charged with an unresolved criminal charge (have you been charged with a crime that has not yet resulted in a plea of guilty, court trial, or dropping of the charge)? Note: A yes answer will not automatically disqualify you from employment. If yes, please explain:   YES 
NO 
comments:

SCHOOL & EDUCATION (Enter institution name, city, state, focus of study, and resulting degree or certifications)
High School  Last Year Completed:
Technical, Vocational,
Business or Military Training 		 Last Year Completed:
College or University  Last Year Completed:
Professional Seminars 

PRIOR WORK RECORD (Start with most recent or present employer)
* Employer 1: 
* Job Title: 
* Duties: 
Address: 
City: 
State:  Zip: 
Date Hired:  Staring Pay: 
Date Left:  Ending Pay: 
Reason for Leaving: 
   Resigned  Discharged  Layoff  Other
* Supervisor: 
* Title: 
* Telephone: 
* Employer 2: 
* Job Title: 
* Duties: 
Address: 
City: 
State:  Zip: 
Date Hired:  Staring Pay: 
Date Left:  Ending Pay: 
Reason for Leaving: 
   Resigned  Discharged  Layoff  Other
* Supervisor: 
* Title: 
* Telephone: 
 
  Employer 3: 
  Job Title: 
  Duties: 
Address: 
City: 
State:  Zip: 
Date Hired:  Staring Pay: 
Date Left:  Ending Pay: 
Reason for Leaving: 
   Resigned  Discharged  Layoff  Other
  Supervisor: 
  Title: 
  Telephone: 
  Employer 4: 
  Job Title: 
  Duties: 
Address: 
City: 
State:  Zip: 
Date Hired:  Staring Pay: 
Date Left:  Ending Pay: 
Reason for Leaving: 
   Resigned  Discharged  Layoff  Other
  Supervisor: 
  Title: 
  Telephone: 


REFERENCES List three work-related individuals that are not former employers
* Name:  * Occupation:  * Phone #: 
* Name:  * Occupation:  * Phone #: 
* Name:  * Occupation:  * Phone #: 

OTHER JOB-RELATED EXPERIENCE: Some people gain job-related experience in positions other than as an employee. Please list and describe any paid or unpaid activities, honors, experience, or training that might aid you in performing the job(s) for which you have applied, and have not been listed previously in this application. (You may omit any activities, honors, memberships or other items that tend to identify your race, sex national origin, age, disability or other personal traits that you prefer not to disclose)

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Click here for the PDM Bridge LLC employment terms