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Social Security Number
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Date of Application |
Date Available |
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Last Name
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First |
Middle |
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Present Address City State Zip |
Phone Number
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Position Desired
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Salary Desired
$ Per |
Are You Presently Employed?
Yes No |
If Yes, Present Salary
$ Per |
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If not employed, state the reason for leaving last position.
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Salary Received
$ Per |
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Were you ever employed by Concentric or any Superior
Energy Company? Yes No |
If Yes, state Company, location, dates and supervisor’s name
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Have you ever been convicted of a felony? Yes No If so, explain:
(Conviction is not an automatic bar to employment) |
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Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes No |
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In case of emergency, whom shall we notify:
Name Address |
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Name of any friends or relatives in the Company: |
How did you learn about the job you are applying for?
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Education |
Name and Location of School |
Graduated
Yes - No |
Degree Received |
Area of Specialization |
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High School |
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College |
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Graduate School |
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Business
Or
Night School |
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Other |
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School Activities and Honors Received |
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Did you hold a part-time job while attending school - describe |
Average Grades |
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Did you serve in the U.S. Armed Forces? Yes No |
If yes, what branch? |
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What languages other than English do you speak?
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Give Employment Records As Completely As Possible Starting With The Last Employer |
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Company Name |
Reason For Leaving |
Dates
From To |
Rate Of Pay |
Give title & Specific Duties |
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Start |
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Final |
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Start |
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Final |
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Start |
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Final |
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Start |
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Final |
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Reference |
Give Two Character References (Not Related To You) |
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Name |
Relationship |
Address And Phone Number |
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The answers to the questions list above are true and correct to the best of my knowledge. I hereby give Authorization to Concentric Pipe & Tool Rentals to contact my previous employers.
My present employer May May not be contacted.
I agree that if I am hired, I will follow and abide by the rules and regulations of the company. In addition, I agree that if I am hired, my employment will be on an at-will basis only. I also acknowledge that the company has the right to terminate me with or without prior notice and with or without cause at anytime and for any reason, either at my opition or at the option of the company. I further acknowledge that no one at the company has the authority to offer me an employment contract or enter into any arrangement for employment with me other than on an at-will basis.
I consent to all of the following pre-employment processes, which are required by Concentric Pipe and Tool Rentals and I further understand that the offer of employment is contingent upon my successfully completing all pre-employment testing.
MVR (review of past driving record) Previous Employer Drug & Alcohol History (DOT applicants)
Drug & Alcohol Screen (DOT & Non-DOT applicants) Physical Examination |
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Signature |
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Date |
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Office Only
Interviewer’s Comments: |
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