APEX Piping Systems, Inc.

Application for Employment

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Last Name:	First Name:	Middle Initial:
Social Security #	Telephone #	Mobile #
E-mail Address

Address
Street:
City:	State:	Zip:

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

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 ShiftSecond ShiftThird 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

Are you able to perform the essential functions of the job for which you are applying? Yes No Need more information

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 Information

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

Employer Name:

Employer Telephone

Street Address:

City: State: Zip:

Starting job title/final job title:

Immediate supervisor and title:

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 Name:

Employer Telephone

Street Address:

City: State: Zip:

Starting job title/final job title:

Immediate supervisor and title:

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 Name:

Employer Telephone

Street Address:

City: State: Zip:

Starting job title/final job title:

Immediate supervisor and title:

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:

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:

Heavy Equipment Qualifications / Training

Light Equipment Qualifications / Training

Educational Background
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

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