Employee Application Form

Section 1: Your Personal Details

First Name:

Middle Name:

Last Name:

Date of Birth:

Mailing Address:

City:

State:

ZIP:

Home Phone Number:

Cell:

Section 2: Position & Eligibility

Position Applied For:

Date Available to Start:

Are you 18 years of age or older?

Are you legally eligible for employment in this country?

Have you ever been convicted of a felony?

If yes, please explain:

Section 3: Education

Name and Location of School

Date Started

Did You Graduate?

Date Graduated (if applicable)

Subjects Studied/Major

High School

Trade School

College

Section 4: Work Experience


Please use the following tabs to enter details of up to three previous positions you have held.


Employer's Name:

Date Employed From:

Date Employed To:

Position:

Phone Number:

Address:

Supervisor's Name:

Salary:

Duties:

Reason for Leaving:

Employer's Name:

Date Employed From:

Date Employed To:

Position:

Phone Number:

Address:

Supervisor's Name:

Salary:

Duties:

Reason for Leaving:

Employer's Name:

Date Employed From:

Date Employed To:

Position:

Phone Number:

Address:

Supervisor's Name:

Salary:

Duties:

Reason for Leaving:

Section 5: Physical Record

Do you have any physical limitations that preclude you from performing any work for which you are being considered?

If yes, please explain:

Section 6: Certifications

Please list all certifications that you hold:

Trade Certifications:

Please look through the following sections and complete all sections that are relevant.

Welding / Structural / Pipe

Qualifying Agency

Date

Active or Expired?

Welding
Structural
Pipe

Crane Operator

What Size Cranes?

Qualifying Agency

Date

Active or Expired?

Equipment Operator Certificates

 

Qualifying Agency

Date

Active or Expired?

Lull/Forklift

Personnel Lift/Man Basket

Scissor Lift

Safety Certificates

 

Qualifying Agency

Date

OSHA 10 Hour

OSHA 30 Hour

Please Read The Following Before Submitting The Form

By clicking the "Submit" button, I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed; falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information that may have personal or otherwise and release all parties from liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period and may regardless of the date of payment of my wages and salary be terminated at any time without prior notice.