Enerfab Inc.

Application for Employment

An Equal Opportunity Employer

Date:

 

First Name

Middle Name

Last Name

 

Street Address

City

State

Zip Code

 

Phone Number

Social Security Number  

 

Are you 18 years of age or older?     Yes No

 

Have you ever been convicted of any misdemeanor or felony (this includes, without limitation, pleading guilty, pleading no contest or having a finding of guilt)?

Yes      No

 

If yes, where, for what, and give dates:
 

Type of Position Applying for (Describe):

 

Part-Time? Full-Time? Summer?

Salary of Rate of Pay Desired? Date available to start work?

Will you work overtime hours if asked?     Yes      No Willing to work shifts?     Yes      No

 

Please list below three persons you have known for at least one year (exclude former employers and relatives).

 

NAME AND OCCUPATION ADDRESS PHONE NUMBER

 

EDUCATION BACKGROUND

Type of School

Name and

Address

 Course of Study Did you graduate? List Degree

or Diploma?

High School
College
Graduate School
Business or Trade
Other

 

 

WORK HISTORY (LIST MOST RECENT EMPLOYER FIRST)

 

Date / Month

and Year

Employers

Name, Address

Phone

Supervisors

Name, Address

Phone

 

Job Title

Duties

 

Salary
Start End

 

Reason For Leaving

 

From:

To:

 

 

 

 

 

 

 
 

From:

To:

 

 

 

 

 

 

 
 

From:

To:

 

 

 

 

 

 

 

From:

To:

 

 

 

 

 

 

 

Are you known to schools/references/employers by another name?     Yes      No

If yes, please indicate the name(s):

 

 

List any special skills or training (e.g. Lotus 1-2-3, word processing, CPA, licenses) you feel we should be aware of in considering your application:

 

 

TO BE COMPLETED ONLY BY APPLICANT FOR CLERICAL POSITIONS

 

Can you type?     Yes      No      W.P.M.

 

Computer Experience:     IBM      H/P       MacIntosh      Other   

 

Office Equipment Experience:     Copier      Fax       Microfiche      Switchboard      Typing

APPLICATION STATEMENT

1. My submitting this form also authorizes ENERFAB, INC. or its authorized agents to conduct a thorough investigation of all statement, written or oral, made by me during the employment application process, including without limitation, information concerning my employment positions, law enforcement record and educational background.  I hereby authorize all persons, companies or other entities connected with any such informational request, including without limitation, current or prior employers and law enforcement agencies to provide any and all information they may have regarding me or my employment.  I release and agree to indemnify Enerfab Inc. its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of such investigation, including without limitation any liability for furnishing information or for taking any action based on the information provided.

2. I hereby certify that all responses set forth during my employment application process are true and complete.  I understand and agree that any falsification, misrepresentation, or omission either on the employment application form or in my responses to questions asked during the interviewing or examination process may disqualify me from further consideration for employment, or if employed by Enerfab Inc. will subject me to immediate termination, whenever the falsification or omission is discovered.  In this regard, where an item is left blank on the employment application, it is because there is no information within its scope.

3. I understand that a drug and/or alcohol screen may be required before and during my employment.  In addition, I authorize a medical examination, including a drug and/or alcohol screen, by an examiner selected by Enerfab Inc. if I am made a contingent offer of employment.  I release and agree to indemnify Enerfab Inc. its authorized agents, and its employees, and all other persons, companies, and other entities from any and all liability arising out of any medical examination or drug/alcohol screen or the taking of any action based on the results of any medical examination or drug/alcohol screen.

4. I certify that I am a Citizen of the United States, or if not I can provide required documentation permitting me to work in the United States.

5. I understand and agree if I am employed by Enerfab Inc. my employment is at will so that I may terminate my employment at any time and for any or no reason.  Likewise, Enerfab can terminate my employment at any time and for any reason or no reason.  I also understand and agree that nothing contained in Enerfab, Incs employment application or in the granting or conduction of an interview or anything set forth in any oral or written statement, communication, or policy now or in the future constitutes or creates or is intended to constitute or to create a contract or promise between me and Enerfab, Inc for employment, hours of work, or for the providing of benefits.  Moreover, I acknowledge that Enerfab, Inc. reserves the right to modify, revoke, suspend, terminate or change any or all of its plans, policies, or procedures at any time, without prior notice.  No promises or guarantees regarding employment, hours of work, or for the providing of benefits have been made to me and I understand and agree that no such promise or guarantee is binding on Enerfab, Inc. unless they are expressed promises, made in writing, and signed by the President of Enerfab Inc.

Applicants Acknowledgement (in lieu of signature)

 

Copyright © 2006 [Enerfab, Inc.]. All rights reserved.
Revised: 11/01/07.