Circle 8 Crane Services - Employee Survey

Date

Name

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

Date

Social Security #

Email

example@example.com

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.)

Are you looking for full-time employment

If no, what hours are you available?

Have you ever been convicted of a felony? (This will not necessarily effect your application.)

If yes, please describe conditions

Position applied for

How did you hear of this opening?

Are you presently employed?

May we contact your present employer?

Are you available for full-time work?

Are you willing to work 2-3 weeks away from home?

Are you willing to work long hours for several days without time off?

Date you can start

Date

Desired Position

Desired starting salary

School Name and Location

Rows	Year	Major	Degree
High School
College
Post-College
Other Training

In addition to your work history, are there any other skills, qualifications, or experience that we should consider?

NCCCO Certified

Date Certified

Date

Years

Months

Coil Tubing/Wireline Experience

Type of cranes operated

Company Name

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date Started

Date

Date Ended

Date

Starting Wage

Ending Wage

Starting Position

Ending Position

Name of supervisor

May we contact

Responsibilities

Reason for leaving

Other reason

Company Name

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date Started

Date

Date Ended

Date

Starting Wage

Ending Wage

Starting Position

Ending Position

Name of supervisor

May we contact

Responsibilities

Reason for leaving

Other reason

Company Name

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date Started

Date

Date Ended

Date

Starting Wage

Ending Wage

Starting Position

Ending Position

Name of supervisor

May we contact

Responsibilities

Reason for leaving

Other reason

Company Name

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date Started

Date

Date Ended

Date

Starting Wage

Ending Wage

Starting Position

Ending Position

Name of supervisor

May we contact

Responsibilities

Reason for leaving

Other reason

Company Name

Address

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date Started

Date

Date Ended

Date

Starting Wage

Ending Wage

Starting Position

Ending Position

Name of supervisor

May we contact

Responsibilities

Reason for leaving

Other reason

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Years Known

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Years Known

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Years Known

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Relationship

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Relationship

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Relationship

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you have a valid drivers license?

License number

State of issue

Expiration date

Date

Commercial (CDL)

List any accidents you’ve had in the last 5 years – date and description

Circle 8 Services will check your driving record for employment purposes; select Yes to verify that you understand this

Will you abide by the safety rules and policies of the company

Have you used any illegal drugs in the last twelve months

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on the application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.

I understand that employment at this company is “at will” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by status. All employment is continued pm that basis. I hereby acknowledge that I have read and understand the above statements.

Attach Resume

Date

Signature

Application for Employment

Employment Desired

Education

Crane Operating Experience

Employment History

Company 1

Company 2

Company 3

Company 4

Company 5

References

Reference 1

Reference 2

Reference 3

Emergency Contact

Contact 1

Contact 2

Contact 3