Employment Application Form

JCB Energy Services is an equal opportunity employer. This application will not be used for limiting or excluding any application from consideration of employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, please contact a company representative.

Applicant Name*

First NameLast Name

Phone Number*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How Did You Hear About Us?

Best Way to Reach You?*

CallEmailTextNo Preference

Will You Consent to the Following?*

A Background CheckA Mandatory Controlled Substance TestA Driving Test

What Type of Position Are You Applying For?*

Please Select All That Apply:

I have a valid Driver's LicenseI have a class A CDLI have reliable transporationI am 18 years or olderI am a US Citizen or approved to work in the United StatesI have 1+ years in the underground/communication industry

Do You Have a Resume to Upload?*

YesNo I Need to Complete an Application Online

Resume and Files*

Please include your cover letter, resume, certifications, references, or additional documentation that would help us with choosing you!

Job Skills/Qualifications:

Please list below the skills and qualfications you possess for the position for which you are applying

PREVIOUS/CURRENT EMPLOYMENT:

Please include up to three previous employers with required information.

Employer Name:*

Job Title:*

Start Date:*

End Date (if employed, state current):*

Supervisor Name:*

Contact Number:*

Please enter a valid phone number.

Please State Employment Responsibilities:*

Employer Name:

Job Title:

Start Date:

End Date (if employed, state current):

Supervisor Name:

Contact Number:

Please enter a valid phone number.

Please State Employment Responsibilities:

Employer Name:

Job Title:

Start Date:

End Date (if employed, state current):

Supervisor Name:

Contact Number:

Please enter a valid phone number.

Please State Employment Responsibilities:

EDUCATION AND TRAINING: Please include any education or training*

	SCHOOL NAME	LOCATION (CITY, ST)	DEGREE EARNED
Education:
Education
Education
Education

References: Please provide 3 personal/professional references*

	NAME	PERSONAL/PROFESSIONAL	PHONE #	EMAIL
Reference:
Reference
Reference