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Sunbelt Industrial Services

Employment Application

Applicant Information
Last Name:
First Name:
Middle Initial:
Date:
Street Address:
Apartment/Unit #
City:
State:
Zip:
Phone:
Email:
Are you over the age of 18? Yes No
Date Available:
Desired Salary: $
Position(s) Applied (for either or both) Drilling Construction
Have you ever been convicted of a felony? Yes No
If yes, can you work outside the residing State? Yes No
Do you have Commercial Drivers License? Yes No
What Type?
Do you have any driving restrictions? Yes No
Can you obtain a Commercial Drivers License? Yes No
Are you a citizen of the United States? Yes No
If no, are you authorized to work in the U.S.? Yes No
Can you travel out of town for extended periods of time (2-3 weeks)? Yes No

If not, explain:
Do you have your own transportation? Yes No

If no, explain:
Education
High School:
City, State:

From:
To:

Did you graduate? Yes No
Degree:
College:
City, State:

From:
To:

Did you graduate? Yes No
Degree:
Other:
City, State:

From:
To:

Did you graduate? Yes No
Degree:
References
Please list three professional references.
Full Name:
Relationship:

Company:
Phone:

City, State:
Full Name:
Relationship:

Company:
Phone:

City, State:
Full Name:
Relationship:

Company:
Phone:

City, State:
Previous Employment
Company:
Phone:

Address:
Supervisor:

Job Title:
Starting Salary: $
Ending Salary: $

Responsibilities:

From:
To:
Reason for leaving:
May we contact your previous supervisor for a reference? Yes No
Company:
Phone:

Address:
Supervisor:

Job Title:
Starting Salary: $
Ending Salary: $

Responsibilities:

From:
To:
Reason for leaving:
May we contact your previous supervisor for a reference? Yes No
Company:
Phone:

Address:
Supervisor:

Job Title:
Starting Salary: $
Ending Salary: $

Responsibilities:

From:
To:
Reason for leaving:
May we contact your previous supervisor for a reference? Yes No
Military Service
Branch:
From:
To:
Rank at discharge:
Type of discharge:
If other than honorable, explain:
Disclaimer and Signature

By submitting my name below, I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:
Date:
Pre-Employment Background Release Form

I hereby authorize the release for pre-employment screening to include: A background check, driving record, or any other information (criminal, credit, driving, workers-comp, education history, as well as information regarding my general character and/or reputation) to help the above said parties in determining my employment.

I release any providers of such information from any liability for providing the same. I understand the information may be reviewed initially and reported to my prospective/actual employer.

I agree that falsification may result in ineligibility for employment or subject to immediate dismissal, if hired. I further acknowledge the release to: my prospective employer, their prospective owners, officers, agents, and employees from any and all liability arising out of errors or omissions.

If not hired based on the report, I understand I have rights under FCRA (Fair Credit Reporting Act) laws including the right to review my report and correct errors.

Signature:
Date of Birth: