Job Application

Employment Application

Personal

Name *

First

Last *

Last

Address *

Address

City

State/Province

Zip/Postal

Country

Date of birth *

Email *

Home phone

Mobile phone

Employment Desired *

Full-time

Part-time

Full- or Part- time

Referred To Us By

Highest Grade Completed *

Year Completed *

GED (if HS not completed)

Yes

Any Special Schooling or Certificates

Experience

Apprentice

# of years

Engineer

# of years

Laborer

# of years

Steel Worker

# of years

Boilermaker

# of years

Foreman

# of years

Millwright

# of years

Pipefitter

# of years

Electrician

# of years

Journeyman

# of years

Machinist

# of years

Welder

# of years

Previous Employers

Previous Employer #1

Job Title

Date From

Date To

Rate of Pay

Supervisor

Supervisor phone number

Duties

Reason for leaving

Previous Employer #2

Job Title

Date From

Date To

Rate of Pay

Supervisor

Supervisor phone number

Duties

Reason for leaving

Previous Employer #3

Job Title

Date From

Date To

Rate of Pay

Supervisor

Supervisor phone number

Duties

Reason for leaving

Personal References

(other than family members or previous employers)

1st Reference

1st Reference Phone Number

2nd Reference Name

2nd Reference Phone Number

3rd Reference Name

3rd Reference Phone Number

Attach Resume

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I understand that Jackson & Jackson Industrial Contractors, Inc. is an equal opportunity employer and will not discriminate in any phase of employment. This application is not an offer of employment or contract. Any employment with Jackson & Jackson Industrial Contractors, Inc. is on an at-will basis. If hired, I or company may terminate the employment relationship at any or without notice or cause.

I certify that the information given in this employment application is true and complete to the best of my knowledge. By my signature, I give full authorization to Jackson & Jackson Industrial Contractors, Inc. to verify any and all information for the purposes of employment. If further authorize Jackson & Jackson Industrial Contractors, Inc. to contact my previous employers for employ references. I release Jackson & Jackson Industrial Contractors, Inc. from any liability associated with contacting my previous employers.

In accordance with the requirements of section 1681(b)(2) of Title 15 of the United States Code, commonly known as the Consumer Credit Protection. Company hereby notifies me that it may obtain a report concerning my credit history and criminal records for employment purposes. Before taking an action based in whole or in part upon such a report, the Company will provide me with a copy of the report and a description of my rights as a consumer the Consumer Credit Protection Act. By signing below, I acknowledge that I consent, voluntarily and without coercion and duress, to procurement of a report detailing my credit history and criminal record and acknowledge my understanding of the terms of this disclosure. I further release Jackson & Jackson Industrial Contractors, Inc. from liability in connection with the obtaining of such reports for the purpose provided herein.

I agree to these terms *

Yes

Signature

Clear