Human Resources employment application

Personal Information

First Name Middle Initial Last Name

E-mail Address

Street Address

City State Zip Code Home Phone Cell Phone

Position Applying For

Position Applying for

Temporary Part-Time Full-Time

Date Available
Pay Expected

Employment History

Currently Employed?

Yes No

If not employed how long since last employment?

Have you worked for us before?

Yes No

From Until

Where? Rate of Pay Position

Reason for leaving.

Names of anyone employed with us:

Education

Highest grade completed: College:

Last school attended:

Address:

Citizenship

Are you a citizen of the United States?

Yes No

If not are you authorized to work in the U.S.?

Yes No

Driver Experience and Qualification

Do you currently hold a CDL?

Yes No

Class A:

Yes No

Tanker endorsement:

Yes No

Doubles:

Yes No

Triples:

Yes No

Haz-Mat:

Yes No

Are you willing to obtain a CDL?

Yes No Already have

Equipment Operation Experience

Please check any equipment you have experience with, and explain in detail your experience on each piece of equipment.

0 = no experience | 1 = entry level 1 yr or less | 2 = 2 - 5 yrs | 3 = 5 yrs or more

Track Hoe:

0 1 2 3

Rubber Tire Hoe:

0 1 2 3

Road Grader:

0 1 2 3

Dozer:

0 1 2 3

Scraper:

0 1 2 3

Fork Lift :

0 1 2 3

Truck:

0 1 2 3

Other:

0 1 2 3

Please explain any roustabout experience you have.

Fusing experience:

1"-4" 6"-8" 10"-14" 16" +

Butt fusion Side wall Hot tap Electra Fuse

Please explain any fusion experience you have.

References

Please list 3 references

1) Full Name:
Company:
Address:
Phone:
Relationship:

2) Full Name:
Company:
Address:
Phone:
Relationship:

3) Full Name:
Company:
Address:
Phone:
Relationship:

Previous Employment

Please list previous employers

Company:
Phone:
Supervisor:
Address:
Job title:
From:
To:
Starting Wage:
Ending Wage:
Reason for leaving:
Duties and Responsibilities:

Company:
Phone:
Supervisor:
Address:
Job title:
From:
To:
Starting Wage:
Ending Wage:
Reason for leaving:
Duties and Responsibilities:

Company:
Phone:
Supervisor:
Address:
Job title:
From:
To:
Starting Wage:
Ending Wage:
Reason for leaving:
Duties and Responsibilities:

Felony Convictions

Have you ever been convicted of a felony?

Yes No

If yes, please explain:

Please enter the word you see in the image below:

Human Resources employment application

Personal Information

Position Applying For

Employment History

Education

Citizenship

Driver Experience and Qualification

Equipment Operation Experience

Please check any equipment you have experience with, and explain in detail your experience on each piece of equipment.

Please explain any roustabout experience you have.

Please explain any fusion experience you have.

References

Please list 3 references

Previous Employment

Please list previous employers

Felony Convictions

After submitting your application you will be redirected back to our job listings.