Position(s) applied for:_____________________________________ Location:________________________________
Date of Application____/____/____
Name: _________________________________________________________________________
___________________
(Last , First & Middle)
Address__________________________________________________________________
_________________________
(Street, City, State & Zip)
Telephone: (______) _________-__________________ Social Security
Number: ______-_____-_________
If you are under 18, can you furnish a work permit: [ ] yes [ ] no
Have you ever been employed here before? [ ] yes [ ] no
Are you legally eligible to work in this country? [ ] yes [
] no
(Proof of identity and legal right to work will be required upon
employment.)
Date available for work:__________________________________
Type of employment desired: [ ] Full-Time [ ] Part-Time [ ] Temporary
Have you been convicted for a felony in the last seven (7) years? [ ] yes [ ] no
If yes, please explain:_________________________________________________________________
(Conviction does not automatically
bar you from employment.)
Driver's license number (if driving required by job): _____________________________State: __________________
Can you, with or without reasonable accommodation, perform
the duties of the job for which you are applying? [ ] yes [ ]
no
Please describe any reasonable accommodation you would need to
perform the job for which you are applying:
______________________________________________________________________ _________________
______________________________________________________________________ _________________
______________________________________________________________________
_________________
Employment History List your last four (4) employers, assignments or volunteer activities, starting with the most recent, including military experience:
#1
From_______To______Employer__________________________Telephone
(______)_________________
Job Title________________________________Address_____________________________
____________
Last Immediate Supervisor and Title__________________________________________________________
Summarize the nature of work performed and job responsibilities:
_________________________________________________________________________
______________
_________________________________________________________________________
______________
_________________________________________________________________________
______________
Reason for Leaving _______________________________________________________________________
Can we contact your Employer? [ ] yes [ ] no
Hourly Rate/Salary Start $__________ per __________ Final $__________
per __________
#2
From_______To______Employer__________________________Telephone
(______)_________________
Job Title________________________________Address_____________________________
____________
Last Immediate Supervisor and Title__________________________________________________________
Summarize the nature of work performed and job responsibilities:
_________________________________________________________________________
______________
_________________________________________________________________________
______________
_________________________________________________________________________
______________
Reason for Leaving _______________________________________________________________________
Can we contact your Employer? [ ] yes [ ] no
Hourly Rate/Salary Start $__________ per __________ Final $__________
per __________
#3
From_______To______Employer__________________________Telephone
(______)_________________
Job Title________________________________Address_____________________________
____________
Last Immediate Supervisor and Title__________________________________________________________
Summarize the nature of work performed and job responsibilities:
_________________________________________________________________________
______________
_________________________________________________________________________
______________
_________________________________________________________________________
______________
Reason for Leaving _______________________________________________________________________
Can we contact your Employer? [ ] yes [ ] no
Hourly Rate/Salary Start $__________ per __________ Final $__________
per __________
#4
From_______To______Employer__________________________Telephone
(______)_________________
Job Title________________________________Address_____________________________
____________
Last Immediate Supervisor and Title__________________________________________________________
Summarize the nature of work performed and job responsibilities:
_________________________________________________________________________
______________
_________________________________________________________________________
______________
_________________________________________________________________________
______________
Reason for Leaving _______________________________________________________________________
Can we contact your Employer? [ ] yes [ ] no
Hourly Rate/Salary Start $__________ per __________ Final $__________
per __________
******
Have you ever been involuntarily terminated from any position? [ ] yes [ ] no If yes, please explain:
______________________________________________________________________
_________________
_________________________________________________________________________
______________
Skills and Qualifications - Summarize special skills and
qualifications acquired from employment or other experience that
may qualify you for work with our Company:
_________________________________________________________________________
______________
_________________________________________________________________________
_____________
_________________________________________________________________________
_____________
Educational Background
Name and Location Years Completed Did You Graduate Course of Study
High School______________________________________________________Did
you Graduate? [ ] yes [ ] no
College___________________________________ Did you Graduate? [ ] yes [ ] no
If so, Major____________________Degree____________________________
Other School______________________________________________________
References:
Name__________________________________Telephone_______________________ ___________Years Known___________
Name__________________________________Telephone_______________________ ___________Years Known___________
Name__________________________________Telephone_______________________
___________Years Known___________
Please read carefully before signing:
I understand and agree that any misrepresentation by me in
this application will be sufficient reason to cancel this application
and/or terminate my employment from the employer's service if
I have been employed. Furthermore, I understand and agree that
if I am employed, I shall be employed on an at-will basis.
I understand that my employment with Vetco is not for a specified
period and can be terminated either by me or by the Company at
any time with or without cause or advance notice. I also understand
that during my employment with Vetco I may either be promoted
or demoted at the Company, in its sole discretion, determines.
I understand that, although other terms and conditions of my employment
may change from time to time at the Company's sold discretion,
this employment at-will policy shall not be modified by any statement
contained in this or any other Company document provided to me
in connection with my employment. Nothing contained in this application
or in other Company documents shall require the Company to have
cause to terminate my employment, or to discipline or demote me,
or otherwise restrict the Company's right to dismiss or demote
me at any time for any reason. I further understand that no person
other than the President of the Company has the authority to enter
into an agreement for employment for a specified term or to make
any agreement contrary to the at-will relationship Vetco maintains
with each of its employees. Any contrary agreement must be in
writing and signed by the President.
I give the employer the right to investigate all references and
to secure additional information about me, if job related. I hereby
release the employer and its resentatives from liability for seeking
such information and all other persons, corporations or organizations
for furnishing such information.
Signature of Applicant: ________________________________________Date:___________________</ P>