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Dura-Bond Job Application
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How Did You Learn About Us?
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Consumer Report Disclosure
Signature
Full Legal Name (please print)
Date
Authorization to Conduct Employment Background Investigation
FULL NAME:
OTHER NAMES USED/MAIDEN NAME/DATES:
CURRENT ADDRESS:
PHONE:
LIST ALL ADDRESSES FOR PAST 7 YEARS:
Dates:
-
Dates:
EMAIL ADDRESS:
SOCIAL SECURITY #:
DATE OF BIRTH:
DRIVER'S LICENSE #:
STATE ISSUED:
*** MAY WE CONTACT YOUR CURRENT EMPLOYER?
SIGNATURE:
DATE:
California, Minnesota & Oklahoma Applicants Only: Please check this box if you would like a copy of the background check mailed to you. Minnesota and Oklahoma applicants will receive a copy direct from Justifacts or its designee. California applicants may receive a copy from either the prospective employer or Justifacts.
Personal Information
Last Name
First Name
MiddleName
Address
City
State
ZipCode
Best time to contact you at home
If you are under 18 years of age, can you provide required proof of eligibility to work?
Have you ever filed an application with us before?
If Yes, give date
Have you ever been employed with us before?
If Yes, give date
Do any of your friends or relatives, other than spouse, work here?
List their names:
Are you currently employed?
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.
Date Available
Desired Salary
Are you available to work:
Please Indicate Shift
Please Indicate Time of Day
Begin Date
End Date
Are you currently on "lay-off" status and subject to recall?
Can you travel if a job requires it?
Education & Training
Elementary School Attended
Elementary School Name
Elementary School Address
Elementary School Started
Elementary School Ended
Qualification / Diploma
High School Attended
High School Name
High School Address
Started
Ended
Qualification / Diploma
College Attended
College Name
College Address
Started
Ended
Qualification / Diploma
Graduate School Attended
Graduate School Name
Graduate School Address
Graduate School Started
Graduate School Ended
Qualification / Diploma
Additional Training
Institution Name
Institution Address
Started
Ended
Qualification / Diploma
Describe any specialized training, apprenticeship, skills and extra-curricular activities.
Describe any job-related training received in the United States military.
Current/Last Job
Job Title
Started
Ended
Company
Salary
Company Address
Phone
ZipCode
Relevant task description
Reason for Leaving
Previous Jobs
Job Title
Started
Ended
Company
Salary
Company Address
Phone
ZipCode
Relevant task description
Reason for Leaving
Job Title
Started
Ended
Company
Salary
Company Address
Phone
ZipCode
Relevant task description
Reason for Leaving
Job Title
Started
Ended
Company
Salary
Company Address
Phone
Zip Code
Relevant Task Description
Reason for Leaving
Job Title
Started
Ended
Company
Salary
Company Address
Phone
Zip Code
Relevant Task Description
Reason for Leaving
List Professional, trade, business or civic activities and offices held.
Other Qualifications
Specialized Skills
WPM
State any additional information you feel may be helpful to us in considering your application.
Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Can you perform the essential functions of the job, for which you are applying, either with or without a reasonable accommodation?
References
Full Name
Company
Position
Address
Phone
E-mail
Full Name
Company
Position
Address
Phone
E-mail
Full Name
Company
Position
Address
Phone
E-mail
Resume
Please Attach Your Resume (pdf, doc or docx files only)
Select file...
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Additional Information
Disclaimer & Signature
I certify that the answers given herein are true and complete.<br /><br />
I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.<br><br>
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 this time.<br><br>
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.<br><br>
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.
Signature
Date
I certify that my answers are true and complete.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Dura-Bond Pipe requires a criminal background check as part of their pre-employment screening. In order to process the background check, the following information is needed.
Date of Birth
Signature
Apply