Employment - Blacklick Energy Pipeline LLC

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Employment

Blacklick Energy LLC. is an Equal Opportunity Employer. This company does not and will not discriminate in employment and personnel practices on the basis of race, sex, age, handicap, religion, national origin or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above listed items.

FILL OUT THE APPLICATION BELOW, When completed , click send:

Items marked with * denoted required fields.

Position Applying For:

Full Name:*

Date:

Street Address:

Apt. #:

City, State, Zip:*

Phone Number:*

E-mail Address:

Social Security Number:

Desired Salary

Are you a citizen of the United States?
Yes
No

If no, are you authorized to work in the U.S.?
Yes
No

Have you ever worked for this company?
Yes
No

If yes, when?

Have you ever been convicted of a felony?
Yes
No

If yes, explain:

Education

High School Attended

Did You Graduate?
Yes
No

College Attended

Did You Graduate?
Yes
No

Degree

Additional Education

Additional Degrees/Certifications

Please list three professional references

FIRST REFERENCE Full Name

Company

Address

Relationship/Position

Phone

SECOND REFERENCE Full Name

Company

Address

Relationship/Position

Phone

THIRD REFERENCE Full Name

Company

Address

Relationship/Position

Phone

EMPLOYMENT HISTORY:

Most Recent Employer

Address

Phone

Supervisor

Job Title

Starting Salary

Responsibilities

Work Start Date - Work End Date

Reason for Leaving

May we contact your previous supervisor for a reference?
Yes
No

Employer 2

Address

Phone

Supervisor

Job Title

Starting Salary

Responsibilities

Work Start Date - Work End Date

Reason for Leaving

May we contact your previous supervisor for a reference?
Yes
No

Employer 3

Address

Phone

Supervisor

Job Title

Starting Salary

Responsibilities

Work Start Date - Work End Date

Reason for Leaving

May we contact your previous supervisor for a reference?
Yes
No

Special Skilla and Abilities

List your special skills and abilities that you possess and believe relevant to the position you seek, such as operating heavy equipment, computer skills, fluency in language(s), etc.

CERTIFICATION AND SIGNATURE

In case of emergency notify: Please list name, address and phone.

Certification of Truthfulness and Electronic Signature*

I am aware that any omissions, falsification, misstatements, or misrepresentation above may disqualify me for employment consideration and, if I am hired, may be grounds for termination at a later date. I understand that any information I give may be investigated as allowed by law. I consent to the release of information about my ability, employment history, and fitness for employment by employers, schools, and other individuals and organizations for employment purposes. This consent shall continue to be effective during my employment if I am hired. I certify that to the best of my knowledge all of the statements contained herein and on any attachments are true, correct, complete, and made in good faith

I agree

Signature: Please type your full name.*

Date*

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