Application

EMPLOYMENT APPLICATION INSTRUCTIONS

This application form is used to evaluate qualifications for determining the essential job function for employment.

Complete all sections of this application form. False or misleading information during the interview and/or on this application form may be reasons for termination.

Qualified applicants will receive consideration without discrimination due to sex, marital status, race, age, creed, national origin, or disabilities.

Position Applying For

Petroleum Construction Installation Laborer

Petroleum Construction Installation Laborer Assistant/Trainee

EPA Petroleum Sump Testing

Other

PERSONAL INFORMATION

Name*

First

Middle

Last

Address

Street

City

State

Zip

Apartment No.

Email address*

Home/Cell Telephone:

Work Telephone:

FORMER EMPLOYERS (List below last three(3) employers, starting with last one first)

Are You Employed Now?

Yes

No

If Yes May We Contact Current Employer?

Yes

No

Company Name:

City/State

Supervisor Name:

Telephone:

Dates Employed:

From:

To:

What Did You Like Most About The Job:

What Did You Like Least About The Job?

Reason for Leaving:

Company Name:

City/State

Supervisor Name:

Telephone:

Dates Employed:

From:

To:

What Did You Like Most About The Job:

What Did You Like Least About The Job?

Reason for Leaving:

Company Name:

City/State

Supervisor Name:

Telephone:

Dates Employed:

From:

To:

What Did You Like Most About The Job:

What Did You Like Least About The Job?

Reason for Leaving:

REFERENCES: (Include only individuals familiar with your work ability, exclude relatives)

Name

Phone

Years Known

Relationship

JOB RELATED SKILLS (Complete Only Those Sections Which Are Job Related)

List Skills, Licenses, Certificates, or Training

If Job Requires, Do You Have a Valid Driver's License?

Yes

No

License No:

Type:

State:

Have you Ever Been Convicted Of A Felony?

Yes

No

If Yes Describe:

I certify that I have read and understand the applicant note on page one of this form and that answers given by me to the foregoing questions and the statements made by me are completely true to the best of my knowledge and belief. I understand that any false information, omission or misrepresentations of facts called for in this application may result in rejection of application and/or discharge at any time during my employment.

I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information including, but not limited to, criminal history, credit history, and motor vehicle driving records. I authorize all persons, schools, companies, and law enforcement authorities to release information concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatsoever for issuing information.

I also understand that the use of illegal drugs is prohibited during my employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior and during employment

Upload Resume & Cover Letter

Date

Email

Signature

The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, and admissibility.

PERSONAL INFORMATION

EMPLOYMENT DESIRED & AVAILABLILITY

EDUCATION

School Level

Location

Dates

Graduate?

High School

Trade, Business or Other School

College

FORMER EMPLOYERS (List below last three(3) employers, starting with last one first)

REFERENCES: (Include only individuals familiar with your work ability, exclude relatives)

JOB RELATED SKILLS (Complete Only Those Sections Which Are Job Related)

Upload Resume & Cover Letter