Usibelli Coal Mine Employment Application

APPLICATION FOR EMPLOYMENT

Usibelli Coal Mine is an equal-opportunity employer. All qualified applicants will be considered for employment without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical or mental disability, medical condition, military or veteran status, genetic information, marital status, ethnicity, citizenship or immigration status or any other protected classification, in accordance with applicable federal, state, and local laws. Those applicants requiring accommodation to complete the application and/or interview process should contact the HR department.
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Cell/Phone Number
Format: (000) 000-0000.
Position(s) or Type of Work Applied For
Earliest Possible Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you under the age of 18?
EMPLOYMENT EXPERIENCE

List the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give firm name and supply business references.
Employer 1 - Name
Employer 1 - Position Title
Employer 1 - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you currently employed by this employer?
Employer 1 - Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 1 - End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 1 - Supervisor Name
Employer 1 - Supervisor Email
example@example.com
Employer 1 - Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 1 - Reason for Leaving
Employer 1 - May we contact this employer?
Would you like to add another employer?
Employer 2
Employer 2 - Employer Name
Employer 2 - Position Title
Employer 2 - Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer 2 - Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 2 - End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 2 - Supervisor Name
Employer 2 - Supervisor Email
example@example.com
Employer 2 - Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 2 - Reason for Leaving
Employer 2 - May we contact this employer?
Would you like to add a third employer?
Employer 3
Employer 3 - Employer Name
Employer 3 - Position Title
Employer 3 - Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer 3 - Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 3 - End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 3 - Supervisor Name
Employer 3 - Supervisor Email
example@example.com
Employer 3 - Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 3 - Reason for Leaving
Employer 3 - May we contact this employer?
Would you like to add a fourth employer?
Employer 4
Employer 4 - Employer Name
Employer 4 - Position Title
Employer 4 - Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer 4 - Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 4 - End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer 4 - Supervisor Name
Employer 4 - Supervisor Email
example@example.com
Employer 4 - Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer 4 - Reason for Leaving
May we contact this employer?
Have you ever been involuntarily terminated or asked to resign from any job?
If yes, please explain.
Please explain any gaps in your employment history.
List any other job-related skills, machines, software knowledge, computer skills, equipment operating skills, trades, mining, other qualifications that you believe should be considered in evaluating your qualifications for this position that are not covered in your cover letter or resume.
Education & Training

Please provide your educational background below. Include only the schools and programs that apply to you.

Rows	School/Institution	Dates Attended	Degree/Certificate	Area of Study/Major
High School
College/University
Graduate/Professional School
Trade School
Other Education or Training

Business & Professional References

Please provide three professional references who can speak to your qualifications, experience, and professional performance. References should not be related to you.

Rows	Name & Title	Relationship	Phone Number	Email
Reference 1
Reference 2
Reference 3

General Information
Have you ever used another name?
Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record?
If yes to either of the above, please provide the additional information:
Have you ever applied for another position at Usibelli Coal Mine before?
Have you ever been employed by Usibelli Coal Mine before?
If yes, please give dates of employment and position(s) worked?
What type of work are you available for?
If hired, would you have a reliable means of transportation to and from work?
Can you travel if the position requires it?
Can you relocate if the position requires it?
If hired, can you present evidence of your identity and legal right to work in this country?
Are you able to perform the essential job functions of the position for which you are applying? (NOTE: We comply with the ADA and consider reasonable accomodation measures that may be necessary for qualified applicants/employees to perform essential job functions.)
What is your desired salary range (annual or hourly)?
Answering "Yes" to the following question does not constitute an automatic bar to employment. Factors such as date of offense, seriousness and nature of the violation and position applied for will be taken into account.
Have you ever been convicted in a court for anything other than a traffic misdemeanor?
If yes, please provide details below.
Upload Resume

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Upload Cover Letter

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Any Other Documents to Upload

You can share certificates, diplomas etc.
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APPLICANT STATEMENT AND AGREEMENT

Please carefully review the following statements. By checking the acknowledgment below and signing this application, you certify that you have read, understand, and agree to these terms.
Full Legal Name

First NameMiddle NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

APPLICATION FOR EMPLOYMENT

EMPLOYMENT EXPERIENCE

Employer 2

Employer 3

Employer 4

Education & Training

Business & Professional References

General Information

APPLICANT STATEMENT AND AGREEMENT