Application for Employment

Personal Information

Name *

First

Middle

Last

Email *

Home/Cell Phone No. *

Secondary/Emergency Phone No.

DOB *

SSN

Present Address

Address Line 1

Address Line 2

City

State

Zip Code

How long have you lived at the address?

Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

How Long did you live there?

Are you over the age of 18? *

Yes
No

If no, employment is subject to verification that you are of minimum legal age.

Are you legally eligible to work in the U.S.? *

Yes
No

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Employment Information

Position(s) applying for: *

Date available for work

What salary or pay rate do you expect?

Type of employment

Full Time
Part Time
Temporary

What days and hours are you available to work?

Days

Hours

Have you ever applied for a job with us before?

Yes
No

Have you ever been bonded?

Yes
No

Bonding means that you have purchased a surety bond

Have you ever been refused a bond?

Yes
No

Have you ever been convicted of a crime, pled no contest or had adjudication withheld?

Yes
No

Do you use illegal drugs?

Yes
No

Does your present employer know of your plans to change employment?

Yes
No

Why do you desire to make a change?

Have you ever held a position of trust (handling money of confidential material)?

Yes
No

Do you have steady transportation to work?

Yes
No

Have you ever been discharged or asked to resign?

Yes
No

Are there any other experiences, skills or qualifications you have that specifically relate to working here?

Do you have any relatives or friends that are currently working here?

Yes
No

Name of relative or friend employed at Keller

First

Last

Can you perform the essential functions of the job for which you’re applying, with or without reasonable accommodation?

Yes
No

If no, please explain.

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Education Information

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Military Service

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Skills

Complete the following section only if these skills are relevant to the applied position. Select "Familiar" next to work with which you are familiar. Select "Skilled" next to work at which you have received specialized training or have significant experience.

Level of Skill

	Familiar	Skilled
Welding(Tig, Mig, Stick)	FamiliarWelding(Tig, Mig, Stick) Familiar	SkilledWelding(Tig, Mig, Stick) Skilled
Pipe Fitting	FamiliarPipe Fitting Familiar	SkilledPipe Fitting Skilled
Layout-Fabrication	FamiliarLayout-Fabrication Familiar	SkilledLayout-Fabrication Skilled
Mechanical	FamiliarMechanical Familiar	SkilledMechanical Skilled
Pneumatics	FamiliarPneumatics Familiar	SkilledPneumatics Skilled
Hydraulics	FamiliarHydraulics Familiar	SkilledHydraulics Skilled
Lathe	FamiliarLathe Familiar	SkilledLathe Skilled
Milling Machine	FamiliarMilling Machine Familiar	SkilledMilling Machine Skilled
Electrical	FamiliarElectrical Familiar	SkilledElectrical Skilled
Motor/PLC Process & Control Circuitry	FamiliarMotor/PLC Process & Control Circuitry Familiar	SkilledMotor/PLC Process & Control Circuitry Skilled
Conduit Running	FamiliarConduit Running Familiar	SkilledConduit Running Skilled
Press-Brake	FamiliarPress-Brake Familiar	SkilledPress-Brake Skilled
Sheer	FamiliarSheer Familiar	SkilledSheer Skilled
Saw	FamiliarSaw Familiar	SkilledSaw Skilled
CAD	FamiliarCAD Familiar	SkilledCAD Skilled

Office Skills

List your specific office skills.

License/Certification/Trades/Skills

List your type of License/Certification/Trades/Skills

Other Qualifications

List any other information which demonstrates your qualifications for the position desired (e.g. special training, language proficiencies, professional memberships, publications, honors, apprenticeships, hobbies and activities).

Other Qualifications

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Employment Experience

Please complete detail starting with most recent employer. List all employers. Attach additional sheets if more space is required.

Employer 1

1. Name of Employer

Address

Phone

Position Title

Start Date

Your End Date

Beginning Salary

Ending Salary

Other Compensation

Immediate Supervisor

First

Last

Reason for Leaving

May we contact this employer?

Yes
No

Summary of Responsibilities:

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References (Business or Personal)

Do not list relatives or former Employers

Select the # of references you have to provide (1-4):

0 References

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IMPORTANT: BY SIGNING THIS APPLICATION I AGREE TO ACCEPT ALL OF THE FOLLOWING CONDITIONS AND TO BE BOUND BY THEM. I UNDERSTAND AND AGREE THAT IF HIRED THESE TERMS BECOME CONDITIONS OF EMPLOYMENT WHICH CONTINUE THROUGHOUT THE ENTIRE COURSE OF MY EMPLOYMENT.

1. Truth and Completeness of Application

The facts set forth above in my application for employment are true and complete. I understand that if employed, false statements or omission of information provided maybe considered sufficient reason for dismissal. You are hereby authorized to make any investigation of my personal history and financial and credit record through any investigative or credit bureaus of your choice. In making this application for employment I also understand that an interview with neighbors, friends, or others with whom I am acquainted. This includes information as to my character, general reputation and personal; Characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation consumer report.

2. Release of Information

I authorize the use of any information in the application to verify my statements, and I authorize the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.

3. Entitlement to work in the United States

I understand and agree that, if hired, I will be required to provide documentation, in accordance with the Immigration Reform and Control Act, demonstrating that I am entitled to work in the United States as an employee of the company.

4. Employment-At-Will

Inconsideration of my employment, I agree to confirm to the rules, regulations and policies of Keller Mechanical and Engineering, Inc. and its affiliates (“Company’s”). I understand that the employment at this organization is on an “at will” basis, and includes no guarantee, contract, or promise of employment for any specific length of time. I understand that no manager or representative of the company, other than the Chief Executive Officer, has an authority to enter into any agreement for employment for employment for any specified period of time, or to make any agreement contrary to foregoing, and that any such agreement must be in writing and signed by Chief Executive Officer in order to legally bind the company.

5. Drug Test

I understand that to be considered for employment with the company I must submit to and pass a urine drug screening test. I hereby agree to submit and authorize the disclosure of the results thereof to the Company.

Signature *

Clear Signature

Date *

Personal Information

Employment Information

Education Information

Grammar or High School Education:

Trade Bus. or Correspondence Education:

College Education:

Graduate Education:

Other Education:

Military Service

Skills

Other Qualifications

Employment Experience

Employer 1

Employer 2

Employer 3

Have more employment experience?

References (Business or Personal)

Reference 1

Reference 2

Reference 3

Reference 4

1. Truth and Completeness of Application

2. Release of Information

3. Entitlement to work in the United States

4. Employment-At-Will

5. Drug Test

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