D&E Equipment Employment Application

APPLICATION FOR EMPLOYMENT

PRE-EMPLOYMENT QUESTIONNAIRE - AN EQUAL OPPORTUNITY EMPLOYER
PERSONAL INFORMATION
DATE
SOCIAL SECURITY NUMBER
LAST
FIRST
MIDDLE
STREET
CITY
STATE
ZIP
PHONE NO.
ARE YOU 18 YEARS OR OLDER?

YES NO
ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?

YES NO
EMPLOYMENT DESIRED
POSITION DESIRED
DATE YOU CAN START
SALARY DESIRED
ARE YOU EMPLOYED NOW?
IF SO, MAY WE CONTACT YOUR PRESENT EMPLOYER?
EVER APPLIED TO THIS COMPANY BEFORE?
WHERE?
WHEN?
REFERRED BY
EDUCATION
GRAMMAR SCHOOL
NUMBER OF YEARS ATTENDED
DID YOU GRADUATE?
SUBJECTS STUDIED
HIGH SCHOOL
NUMBER OF YEARS ATTENDED
DID YOU GRADUATE?
SUBJECTS STUDIED
COLLEGE
NUMBER OF YEARS ATTENDED
DID YOU GRADUATE?
SUBJECTS STUDIED
TRADE/BUSINESS/CORRESPONDENCE SCHOOL
NUMBER OF YEARS ATTENDED
DID YOU GRADUATE?
SUBJECTS STUDIED
GENERAL INFORMATION
SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK
SPECIAL SKILLS
ACTIVITIES
MILITARY OR NAVAL SERVICE
RANK
PRESENT MEMBERSHIP IN NATIONAL GUARD OR RESERVES
FORMER EMPLOYERS
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
DATES WORKED MONTH AND YEAR - FROM AND TO
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
DATE WORKED MONTH AND YEAR - FROM AND TO
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
DATES WORKED MONTH AND YEAR - FROM AND TO
NAME AND ADDRESS OF EMPLOYER
SALARY
POSITION
REASON FOR LEAVING
DATES WORKED MONTHS AND YEAR - FROM AND TO
WHICH OF THESE JOBS DID YOU LIKE BEST?
REFERENCES
REFERENCE #1 - NAME
ADDRESS
BUSINESS
YEARS ACQUAINTED
REFERENCE #2 - NAME
ADDRESS
BUSINESS
YEARS ACQUAINTED
REFERENCE #3 - NAME
ADDRESS
BUSINESS
YEARS ACQUAINTED
WHAT DID YOU LIKE THE MOST ABOUT THIS JOB?
EMERGENCY CONTACT - IN CASE OF AN EMERGENCY NOTIFY
NAME
ADDRESS
PHONE NUMBER
I certify that all the information submitted by me on this application is true and complete, and I understand that if any false infomration, omissions, or misrepresentations are discovered, my application may be rejected. If I am in consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that ther terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.
DATE

Month Day Year
Date
SIGNATURE

Clear
HOW DO YOU RATE YOURSELF?
KNOWLEDGE AND USE OF HAND TOOLS (WRENCHES, DRILLS, SAWS, HAMMERS, PUNCHES, ETC.)

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
KNOWLEDGE AND USE OF ELECTRIC ARC WELDERS

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
KNOWLEDGE AND USE OF OXY-ACETELYNE TORCH

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
ABILITY TO READ AND UNDERSTAND ASSEMBLY INSTRUCTIONS FOR EQUIPMENT

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
KNOWLEDGE OF ELECTRICAL WIRING, MOTORS, ELECTRICAL CONTROLS, ETC.

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
KNOWLEGE OF CONVEYORS, HOW THEY WORK, & HOW THEY ARE CONSTRUCTED

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
KNOWLEDGE OF GRAIN STORAGE AND DRYING EQUIPMENT CONSTRUCTION & OPERATION

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
KNOWLEDGE OF HOW TO DO CEMENT WORK (SITE PREP, INSTALLATION OF REBAR, SETTING FORMS, POURING CEMENT, ETC.)

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
ABILITY TO CLIMB STRUCTURES AND WORK SAFELY WITH HAND TOOLS WHILE TIED OFF WITH A SAFETY BELT AND LANYARD. Although our employees work at ground level most of the time, there are other times when work must be done on grain bin roofs, elevator legs, etc. that may be very tall.

EXCELLENT ABOVE AVERAGE AVERAGE I AM AFRAID OF HEIGHTS
List any specific qualifications that you have that you feel would benefit D & E
ABILITY TO WORK WITH OTHERS AND GET ALONG WITH THEM.

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
WILLINGNESS TO ACCEPT AND CARRY OUT INSTRUCTIONS.

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
ATTENDANCE AND PUNCTUALITY.

EXCELLENT ABOVE AVERAGE AVERAGE BELOW AVERAGE
HAVE YOU EVER BEEN CONVICTED OF A FELONY?

YES NO
If you answered yes please explain
DO YOU HAVE A VALID DRIVERS LICENSE?

YES NO
DO YOU HAVE A CDL DRIVER'S LICENSE?

YES NO
HAVE YOU HAD ANY VIOLATIONS AGAINST YOUR DRIVER'S LICENSE DURING THE LAST THREE YEARS?

YES NO
Violation
Date

Month Day Year
Date
Violation
Date

Month Day Year
Date
Violation
Date

Month Day Year
Date
WHAT PERSONALITY TRAITS DO YOU HAVE THAT YOU BELIEVE WILL MAKE YOU A GOOD EMPLOYEE AT D&E EQUIPMENT?
I certify that all the information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and,ifI am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice at any time by the company.
D&E Equipment Expectations
D & E Equipment Company is entering a very busy part of its work year. Its employees will be asked to work long hours. We are looking for people who are at work on time every day, are willing to take instructions from others, and work quickly, efficiently, and safely.

If you come to work at D & E Equipment Company you will be expected to: 1. Be at work on time every day. 2. Listen to what your supervisor tells you to do, and then do it as quickly, efficiently, and safely as you can. 3. Ask questions if you are not sure about something. Our work is very diversified, so no one is expected to know everything right away. Learn not only what you are supposed to do, but why you are doing it. Don't make the same mistake twice. 4. Be aware of what you are doing and how it may affect your safety and the safety of those around you. If you believe that there is a problem with safety, please report it to your supervisor immediately so that he is aware of it and can take corrective action. 5. Conduct yourself in a manner that shows you and D & E Equipment in a positive light to anyone that might be watching. This means that you are to work in a professional manner, be courteous to others, use acceptable language, and don't mis-use equipment.

I have read the requirements listed above and I will comply with them.
Signed

Clear
Date

Month Day Year
Date
Should be Empty:

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APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

EMPLOYMENT DESIRED

EDUCATION

GENERAL INFORMATION

FORMER EMPLOYERS

REFERENCES

EMERGENCY CONTACT - IN CASE OF AN EMERGENCY NOTIFY

HOW DO YOU RATE YOURSELF?

D&E Equipment Expectations