Application for Employment
NOTICE: Applicant should read the following information carefully before filling out any of the questions in this form. Title VII of the Civil Rights Act of 1964, as amended, prohibits discrimination in employment because of race, color, sex, religion, or national origin.
Personal Information
Date
*
-
Month
-
Day
Year
Date
Social Security Number
###-##-####
Name
*
Last
First
Middle
Maiden
Mailing Address
*
Street/PO Box
County
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Street Address
*
Street Address
County
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Mobile Number
*
Please enter a valid phone number.
Other Number
Please enter a valid phone number.
In case of emergency, please notify:
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Relationship
*
If hired, can you provide proof that you are eligible to work in the United States?
*
Yes
No
If hired, can you provide proof that you are 18 years of age or older (if requested)?
*
Yes
No
State name and department of any relatives already employed by this company.
Referred by:
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Employment Desired
Position
*
Date You Can Start
*
-
Month
-
Day
Year
Date
Salary Desired
Preferred Shift
*
Day
Night
Open
Preferred Status
*
Full-time
Part-time
Shutdowns Only
Are you willing to work overtime?
*
Yes
No
Are you willing to work weekends?
*
Yes
No
Are you available for out of town jobs?
*
Yes
No
Are you employed now?
*
Yes
No
If so, may we inquire of your present employer?
*
Yes
No
Does not apply
Have you ever worked for this company before?
*
Yes
No
Where?
When?
Have you applied with this company before?
*
Yes
No
When?
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Education
High School Name
*
High School Location
*
City, State
Number of years completed
*
Did you graduate?
*
Yes
No
Subjects Studied/Degree(s) received
*
College Name
College Location
City, State
Number of years completed
Did you graduate?
Yes
No
Subjects Studied/Degree(s) received
Trade, Business, or Correspondence School Name
Trade, Business, or Correspondence School Location
City, State
Last year completed
Did you graduate?
Yes
No
Subjects Studied/Degree(s) received
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Special Training
Do you have any of the following?
NCCCO (Crane Certification)
Yes
No
NCCCO Expires:
MSHA
Yes
No
MHSA Date Completed
OSHA 10 hr
*
Yes
No
OSHA 30 hr
Yes
No
Trade Certifications
Pipefitter
Rigger
Ironworker
Millwright
Electrician
Other
Check kinds of work in which you have had experience.
Structural Welding
Pipe Welding
Alloy Welding
Pipe TIG welding
MIG Welding
Pipe Fitting
Tank Fitting
Job Shop Fabrication
Iron Work
Pipe Insulation
Millwright - Mechanical
Millwright - Precision
Industrial Electrical
Concrete Finishing
Concrete Form Work
Industrial Carpentry
Industrial Painting
Industrial Sandblasting
Shipping/Receiving/Toolroom
Truck Driving
Check the types of vehicles and/or equipment you are qualified to operate.
Passenger car
Forklift
Aerial Lift
Excavator
Light Truck
JLG Manlift
Backhoe
Crane (Friction)
Trackhoe
Heavy Truck or Tractor
Scissor Lift
Bobcat
Crane (Hydraulic)
Trencher
Lull
Boom Truck
Shear
Lathe
If you checked Crane (Friction), number of tons:
If you checked Crane (Hydraulic), number of tons:
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Driver's License Number
*
State
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Expires
*
-
Month
-
Day
Year
Date
Ever suspended or revoked?
*
Yes
No
CDL?
*
Yes
No
Do you have reliable transportation to/from work?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
If yes, are you still on probation or parole?
*
Yes
No
Does not apply
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Military Service
Branch of Service
Discharge Date
-
Month
-
Day
Year
Date
Presently in National Guard or Reserves?
Yes
No
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Employment History
List completely the last four employers, starting with last one first.
Job #1 - From Date (Month and Year)
Job #1 - To Date (Month and Year or "Present")
Job #1 - Name and Address of Employer
Job #1 - Supervisor Name
Job #1 - Supervisor Phone Number
Please enter a valid phone number.
Job #1 - Salary
Job #1 - Position
Job #1 - Reason for Leaving
Job #2 - From Date (Month and Year)
Job #2 - To Date (Month and Year)
Job #2 - Name and Address of Employer
Job #2 - Supervisor Name
Job #2 - Supervisor Phone Number
Please enter a valid phone number.
Job #2 - Salary
Job #2 - Position
Job #2 - Reason for Leaving
Job #3 - From Date (Month and Year)
Job #3 - To Date (Month and Year)
Job #3 - Name and Address of Employer
Job #3 - Supervisor Name
Job #3 - Supervisor Phone Number
Please enter a valid phone number.
Job #3 - Salary
Job #3 - Position
Job #3 - Reason for Leaving
Job #4 - From Date (Month and Year)
Job #4 - To Date (Month and Year)
Job #4 - Name and Address of Employer
Job #4 - Supervisor Name
Job #4 - Supervisor Phone Number
Please enter a valid phone number.
Job #4 - Salary
Job #4 - Position
Job #4 - Reason for Leaving
Are you willing to take a physical examination and/or drug test at our expense?
*
Yes
No
Do you have your own tools for your trade?
No
Yes
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READ CAREFULLY:
I authorize investigation of all statements contained in this application. I certify that all information submitted by me is true and complete, and I understand that false statements, misrepresentations or omission of facts are causes for rejection of application or dismissal (if already employed). Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice.
Date
*
-
Month
-
Day
Year
Date
Signature
*
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