Job Application - Western Shamrock

Basic Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Country

Home Phone*

Cell Phone*

Email

Are you licensed to drive a car?*

Yes
No

Are you 18 years of age or older?*

Yes
No

Education

What High School did you attend?*

Did you graduate?*

Yes
No

What college did you attend?*

Did you graduate?*

Yes
No

Other (Name and Type)

Desired Position

What position are you applying for?

What is the wage desired?

State*

Please Select Your Branch*

Desired Schedule

Full Time
Part Time

Have you ever applied here before?*

Yes
No

Employment

Start with most recent and complete in full.
**Last 3 jobs Required**

Employer 1*

Please provide the name of you employer. If not applicable please type 'NA' in the field.

Employer 1 Phone

Dates Employed*

Starting Month/Year - Ending Month/Year

Employer 1 Address

Street Address Address Line 2 City State ZIP

Supervisor’s Name*

Ending Salary/Wage*

Job Title*

Job Duties*

Reason For Leaving*

Employer 2*

Please provide the name of you employer. If not applicable please type 'NA' in the field.

Employer 2 Phone

Dates Employed*

Starting Month/Year - Ending Month/Year

Employer 2 Address

Street Address Address Line 2 City State ZIP

Supervisor’s Name*

Ending Salary/Wage*

Job Title*

Job Duties*

Reason For Leaving*

Employer 3*

Please provide the name of you employer. If not applicable please type 'NA' in the field.

Employer 3 Phone

Dates Employed*

Starting Month/Year - Ending Month/Year

Employer 3 Address

Street Address Address Line 2 City State ZIP

Supervisor’s Name*

Ending Salary/Wage*

Job Title*

Job Duties*

Reason For Leaving*

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Personal Reference

Personal Reference may not be family. Minimum 3 references.

Name*

Relationship*

Address*

Phone*

Name*

Relationship*

Address*

Phone*

Name*

Relationship*

Address*

Phone*

Agreement

APPLICANT: READ AND SIGN BELOW. SIGNING MEANS AGREEMENT: The information provided in the Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. I agree that the Company may obtain a Motor Vehicle Report (MVR) on me. Results may cause dismissal/no hire. I authorize you to conduct a criminal background check. If you decide to engage an investigative consumer-reporting agency to report on my credit and personal history, I authorize you to do so. If a report is obtained you must provide, at my request, the name of the agency so I may obtain from them the nature and substance of the information contained in the report. I authorize you to verify my employment with employers listed on this application. I voluntarily and knowingly authorize any present or past employer or supervisor, college or university or other institution of learning, administrator, law enforcement agency, state agency, local agency, federal agency, credit bureau, collection agency, private business, military branch or the national personnel records center, personal reference, and/or any other person to give records of information that may have concerning my criminal history, motor vehicle history, social security number, earnings history, character, employment (including reasons for termination), credit history, credit capacity, credit standing or any other information requested by Western-Shamrock Corporation deemed pertinent to my employment. Information obtained may be used in employment decisions including termination.

Okay to contact if currently employed

Name*

Electronic signature

Today's Date*

Voluntary Questionnaire

How did you hear about Western-Shamrock Corporation?

If Other, Please Describe

If Referred, please specify who referred you.