Employment Application – FiberChem | Nationwide Pipe and Tank Insulation Company

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APPLICATION FOR EMPLOYMENT

Candidates are required to pass a drug screen and a physical to be considered for employment. We consider applications for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, sexual orientation, citizenship status, genetic information or any other legally protected status.

Today's Date*

Position(s) applying for.

How did you hear about us?

CONTACT INFORMATION

Last Name*

First Name*

Middle Name

Phone*

Email*

Current Address

Street City State Zip

Permanent Address

Street City State Zip

JOB ELEGIBILITY

If you are under 18 years of age, can you provide required proof of work eligibility?*

Yes

No

Do any of your friends or relatives, other than spouse, work here?

Are you currently on "lay-off" status and subject to recall?

Are you currently employed?

Yes

No

May we contact your current employer?

Yes

No

Can you travel if a job requires it?

Yes

No

Have you ever filed an application with us before?*

Yes

No

Have you ever been employed with us before?*

Yes

No

If you have filed an application and/or have been employed by us before please provide details.

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? * Proof of citizenship or immigration status will be required upon employment.*

Yes

No

DESIRED JOB STATUS

Date available to start.*

Availability (check all that apply)

Full Time

Part Time

Temporary

What is your desired wage?

Conflicts? Please list any including other employment & class schedules.

EDUCATION

Highest grade of school completed

School or Program

Location

Major

Degree

Continued Education/Trade School/Specialized Classes

Do you have any special training, skills, or experience that is relevant to the position of which you are applying?

Yes

No

Please specify

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

(Position 1) Employer Name, Address, City, State

Dates Employed

To

Hourly Rate/Salary

Phone Number(s)

Job Title

Supervisor(s)

Work Performed

Reason for Leaving

(Position 2) Employer Name, Address, City, State

Dates Employed

To

Hourly Rate/Salary

Phone Number(s)

Job Title

Work Performed

Reason for Leaving

( Position 3) Employer Name, Address, City, State

Dates Employed

To

Supervisor(s)

Phone Number(s)

Job Title

Work Performed

Reason for Leaving

(Position 4) Employer Name, Address, City, State

Dates Employed

To

Supervisor(s)

Phone Number(s)

Job Title

Work Performed

Reason for Leaving

Additional Employment Space (if needed)

JOB RELATED SKILLS

Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experience.

Describe any job-related training received in the United States military.

References

List three people not related to you to attest to your professional abilities and character.

1) Name, Address, City, State

Phone

1) Name, Address, City, State

Phone

1) Name, Address, City, State

Phone

Terms*

I certify that answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an 'at will' nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this 'at will' employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I agree*

Digital Signature of Applicant (type full name) *

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Email

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