CCU Mining Online Employment Application Form
Please fill out our convenient online coal mining, excavation and construction employment form and we will contact you as soon as we are able. You may also contact us by phone at 740-622-6302, email at info@ccucoal.com, or our mailing address at PO Box 1027, Coshocton, Ohio 43812.
Date
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Month
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Day
Year
Date
First Name
*
Last Name
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone #
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Alternate Phone #
Are you at least 18 years of age?
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Yes
No
If hired, can you present proof of your legal right to work in The United States?
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Yes
No
Have you ever been convicted of a criminal offense?
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Yes
No
If yes, please explain.
Have you ever worked for CCU Mining, LLC or Oxford Mining Company in the past?
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Yes
No
If yes, previous dates of employment:
Disposition:
Do you have any relative(s) or person(s) with whom are you involved in a close personal relationship employed by CCU Mining, LLC?
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Yes
No
Name
Relationship
Position(s) desired:
Shift desired:
Hours desired:
Date available:
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Month
-
Day
Year
Date
Coal Mining & Construction Education and Training
Professional Licenses
Has your license ever been revoked or suspended?
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Yes
No
If yes, state reason(s), date(s) or revocation, and date(s) of reinstatement:
Coal Mining & Construction Equipment Operation Skills
List the equipment you are qualified to operate, the number of years for each, and whether you possess any special licenses, certificates or training:
Other special skills or training
Coal Mining & Construction Work Experience
List the most recent employment first and list the past 10 years of employment.
Coal Mining Experience/Coal Mining Safety-Related Information
Have you worked in a coal mining operation within the last 5 years?
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Yes
No
If yes, list the last mine you worked in and the date you left:
Do you have a current coal mine safety training certificate?
*
Yes
No
If yes, date:
Trainer
Does your training certificate include surface and coal?
*
Yes
No
Do you have a West Virginia Class 07 safety card?
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Yes
No
Signature
Submit
Should be Empty: