Employment Application - Cooper Contracting

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer – All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. A background check showing no felony convictions within the last 7 years is a requirement for hire for any FRA regulated positions within the company.

PERSONAL INFORMATION

Incomplete information could disqualify you from further consideration. Please complete all fields.

Name

First Last

Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Are you eligible to work in the U.S?

Yes
No

Are you at least 18 years or older?

Yes
No

(If no, you may be required to provide authorization to work.)

What languages do you speak or write fluently?

Have you ever been terminated from employment or asked to resign by an employer?

Yes
No

If yes, please provide company names and details

Driver’s License State

Driver’s License #

Driver’s License Expiration Date

Are you a commercially licensed driver (CDL)?

Yes
No

If yes, please fill out the application for CDL drivers.

Do you have vertical & overhead welding experience?

Yes
No

If yes, how many years?

Please enter a number from 0 to 99.

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Yes
No

EMPLOYMENT DESIRED

Date

Hourly Rate/Salary desired

Position desired

Are you currently employed?

Yes
No

If so may we inquire of your present employer?

REFERRAL SOURCE

How did you hear about us?

Walk In
Facebook
Referral
Other

Have you ever worked for this company before?

Yes
No

Explain

Do you know anyone who works for our company?

Yes
No

If yes, who?

EMPLOYMENT HISTORY

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employer #1

From

To

Employer

Telephone #

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Reason for Leaving

Summarize job responsibilities

Employer #2

From

To

Employer

Telephone #

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Reason for Leaving

Summarize job responsibilities

Employer #3

From

To

Employer

Telephone #

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Reason for Leaving

Summarize job responsibilities

Employer #4

From

To

Employer

Telephone #

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Reason for Leaving

Summarize job responsibilities

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for? If yes, explain.

Education

High School

Name and Location

Years Attended

Degree Received

Subjects Studied/Major

College

Name and Location

Years Attended

Degree Received

Subjects Studied/Major

Trade, Business or Correspondence School

Name and Location

Years Attended

Degree Received

Subjects Studied/Major

REFERENCES

Give the names of three persons not related to you, whom you have known at least three (3) years.

Reference #1

Reference #1 Name

First Last

Reference #1 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #1 Phone

Reference #1 Email

Reference #1 Company

Reference #1 Years Acquainted

Reference #2

Reference #2 Name

First Last

Reference #2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #2 Phone

Reference #2 Email

Reference #2 Company

Reference #2 Years Acquainted

Reference #3

Reference #3 Name

First Last

Reference #3 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #3 Phone

Reference #3 Email

Reference #3 Company

Reference #3 Years Acquainted

Please read carefully before signing.

Cooper Rail Service, Inc. dba Cooper Contracting is an equal opportunity employer. Cooper Rail Service, Inc. does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Cooper Rail Service, Inc. to hire me. If I am hired, I understand that either Cooper Rail Service, Inc. or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Cooper Rail Service, Inc. has the authority to make any assurance to the contrary.

The undersigned has applied to become an employee in a position which could involve the operation of a motor vehicle. I consent to the release of my driving record (MVR) for review by the company for the purpose of initial and continued employment.

I attest with my signature below that I have given to Cooper Rail Service, Inc. true and complete information on this application. No requested information has been concealed. I authorize Cooper Rail Service, Inc. to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Date

Signature

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE SIGNED/DATED ABOVE.

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