Application

8025 Iron Tower Court, Colorado Springs, CO 80939

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

Please fill out all of the sections below:
Applicant Name
Address

Address

Street Address Line 2

City State andState / Province

Zip Code
Telephone
Number
Email Address
example@example.com
Date of Application

MonthDayYear
Date
Employment Position
Position(s) applying for: Laborer
How did you hear about this position
On what date can you start working if you are hired

MonthDayYear
Date
Do you have reliable
transportation to and from work
Do you have any friends, relatives, or

acquaintances working for JCB Energy Services
Yes
If yes state name relationship
Are you 18 years of age or older? Are you a U.S. citizen or approved to work in the

What document can you provide as proof of
What document can you provide as proof of citizenship or legal status
Will you consent to a mandatory controlled

Have you ever been convicted of a criminal offense (felony or misdemeanor)? If yes, please state the nature of the crime(s), when and
If yes please state the nature of the crimes when and where convicted and disposition of the case
where convicted and disposition of the case:
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered

Job Skills/Qualifications Please list below the skills and qualifications you possess for the position for which you are applying:

(Note: JCB Energy Services complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. )
Name
Location City State
Year Graduated
Degree Earned
Name
Vocational School/Specialized Training Location (City, State)
Are you a member of the Armed Services
What branch of the military did you enlist
What was your military rank when discharged
How many years did you serve in the military
What military skills do you possess that would be an asset for
What military skills do you possess that would be an asset for this position
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City State and ZipState / Province

Postal / Zip Code
Code
Employer
Dates Employed
Dates Employed

MonthDayYear
Date
Reason for leaving
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City State and ZipState / Province

Postal / Zip Code
Code
Employer
Dates Employed
Dates Employed

MonthDayYear
Date
Reason for leaving
Employer Name
Job Title
Supervisor Name
Address

Employer Address

Street Address Line 2

City State and ZipState / Province

Postal / Zip Code
Code
Employer
Dates Employed
Dates Employed

MonthDayYear
Date
Reason for leaving
References Please provide 3 personal and professional reference(s) below:
Reference
Contact Information
The relationship between you and the JCB Energy Services is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the JCB Energy Services . No representative of JCB Energy Services has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's
Applicant Signature

Clear
Dated

MonthDayYear
Date
Should be Empty: