Application for Employment

APEX PIPING SYSTEMS, INC.
302 Falco Drive
Newport, DE 19804 USA
(302) 995-6136

 

 

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Personal Information

Name

                        Last                                                First                                            Middle


Social Security #
 

Address

                                                Street                                                                                City                                    State                Zip Code


Telephone #


E-mail Address


Mobile/Beeper/Other Phone #

Position(s) applied for

        If other, please list desired position


How did you hear of our company?


If necessary, best time to call you at home is

May we contact you at work? Yes No
If yes, work number: Best time to call:

If you are under 18 and it is required, can you furnish a work permit? Yes No
If no, please explain:

Have you submitted an application here before? Yes No
If yes, give date(s) and position(s):

Have you ever been employed here before? Yes No
If yes, give dates:

Are you legally eligible for employment in this country? Yes No

Date available for work

    If other, what date are you available?


What is your desired salary range or hourly rate of pay?

Type of employment desired:

Will you relocate if job requires it? Yes No

Will you travel if job requires it? Yes No

 

Are you available to work shifts? Yes No

    If yes, what shifts can you work? First Shift  Second Shift  Third Shift

If they have been explained to you, are you able to meet the attendance requirements of the position? N/A Yes No

Will you work overtime if required? Yes No
If no, please explain:

Are you able to perform the essential functions of the job for which you are applying?

        Yes

        No

        Need more information about the job functions and details to respond

Driver's license number if driving may be required in the job for which you are applying: State

Have you ever been bonded? Yes No

Have you ever pleaded "guilty" or "no contest" to, or been convicted of a crime? Yes No
If yes, please provide date(s) and details:

Have you entered into an agreement with any former employer or other party (such as a non-competition agreement) that might, in any way, restrict your ability to work for our company? Yes No
If yes, please explain:
 

Employment History


Starting with your most recent employer, provide the following information.
 

Employer   Telephone #
 

Address

                                                            Street                                                                                City                                    State                Zip Code


Starting job title/final job title
 

Immediate supervisor and title (for most recent position held)
May we contact for reference? Yes No
 

Why did you leave?
 

Dates employed: to


Compensation (Starting) $ per
 

Compensation (Final)      $ per
   

Did you receive any Commissions, Bonuses, or other Compensation? Yes No

     If so, please describe and indicate amount received and frequency.

    


Summarize the type of work performed and job responsibilities.


What did you like most about the job?


What were the things you liked least about the job?

 

 

Employer   Telephone #
 

Address

                                                            Street                                                                                City                                    State                Zip Code


Starting job title/final job title
 

Immediate supervisor and title (for most recent position held)
May we contact for reference? Yes No
 

Why did you leave?
 

Dates employed: to


Compensation (Starting) $ per
 

Compensation (Final)      $ per

 

Did you receive any Commissions, Bonuses, or other Compensation? Yes No

     If so, please describe and indicate amount received and frequency

    


Summarize the type of work performed and job responsibilities.


What did you like most about the job?


What were the things you liked least about the job?

 

 

Employer   Telephone #
 

Address

                                                            Street                                                                                City                                    State                Zip Code


Starting job title/final job title
 

Immediate supervisor and title (for most recent position held)
May we contact for reference? Yes No
 

Why did you leave?
 

Dates employed: to


Compensation (Starting) $ per
 

Compensation (Final)      $ per
 

Did you receive any Commissions, Bonuses, or other Compensation? Yes No

     If so, please describe and indicate amount received and frequency

    


Summarize the type of work performed and job responsibilities.


What did you like most about the job?


What were the things you liked least about the job?

 


Explain any gaps in your employment, other than those due to personal illness, injury or disability.



If not addressed on previous page, have you ever been fired or asked to resign from a job? Yes No
If yes, please explain:
 

Skills and Qualifications


Please check any of the industries below that you have worked in:

Aerospace
Petroleum & Refining
IT / Computer Hardware or Software
Food & Beverage
Ship Construction
Power Generation
Nuclear Construction
Industrial Construction

Automotive
Chemical & Plastics
Electronic
Carpentry
Pharmaceutical
Textile

Other (Please specify )

 

Please identify any specific or unique skills you obtained from working in any of the above industries:

 

 

Please identify any of the equipment you are qualified to operate:


Heavy Equipment Qualifications / Training



Light Equipment Qualifications / Training

 

Educational Background
Starting with your most recent school attended, provide the following information.
 

School (include City & State)
Years Completed
Diploma GED Degree Certification Other
GPA and Class Rank
Major/Minor
School (include City & State)
Years Completed
Diploma GED Degree Certification Other
GPA and Class Rank
Major/Minor
School (include City & State)
Years Completed
Diploma GED Degree Certification Other
GPA and Class Rank
Major/Minor

 

References
List name and telephone number of two business/work references who are not related to you and are not previous supervisors. If not applicable, list two school or personal references who are not related to you.
 

Name
Title
Relationship to You
Telephone
Number of Years Known

Name
Title
Relationship to You
Telephone
Number of Years Known


Related Information
To what job-related organizations (professional, trade, etc.) do you belong?
 

Organization
Offices Held

Organization
Offices Held


List special accomplishments, publications, awards, patents, etc.



In any current or a previous job, have you ever written instructions or directions to be followed by employees or customers? Yes No N/A
If yes, please explain:

Is there any other job-related information you want us to know about you?



Statement of Applicant


I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.


I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resumé or job interview.  I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.


I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or without prior notice, except as may be required by law.

 

This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer's president.


I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.


This Company does not tolerate unlawful discrimination in its employment practices.

 

This Company does not tolerate harassment.  Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.


DO NOT E-SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT OF APPLICANT.

By my E-Signature below, I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Please signify your acceptance by entering your full name in the field below.

E-Signature of Applicant