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Home
Projects
Nordstrom Rack
Bank of America
21st Floor of 1835 Market
Who We Are
What We Do
Safety and Sustainability
History of Cippco
Join our Team
Contact Us
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Join our Team
Employment
CIPPCO PRE-EMPLOYMENT APPLICATION
(PART 1) PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE ALL APPLICANTS WILL BE DRUG TESTED PRIOR TO EMPLOYMENT
SECTION A: GENERAL INFORMATION
Date
*
MM slash DD slash YYYY
Name
*
Last*
First*
Middle
Maiden
Present address:
*
Number*
Street*
City*
State*
Zip*
How long at current address:
Marital Status:
*
Your Cell #
*
Your Home#
Your Email Address:
*
Date of Birth:
*
For Emergency:
Contact Name
*
Number:
*
Position applied for (1)
*
Days/hours available to work
*
No Pref
Mon
Tue
Wed
Thur
Fri
Sat
Sun
Office Only Tasks: Circle skills:
Quickbooks, Outlook, Excel, Word, Power point
How many hours can you work weekly?
*
Can you work nights?
*
How many hours can you work weekly?
*
Full-Time Only
Part-Time Only
Full- Or Part-Time
When available for work?
*
DO YOU HAVE A DRIVER’S LICENSE?
*
YES
NO
Attach photo color copy
Max. file size: 50 MB.
DO YOU HAVE A UNION CARD?
*
YES
NO
Attach photo color copy
Max. file size: 50 MB.
What is your means of transportation to work?
Driver’s license #
*
State of issued:
*
Expiration date:
*
Type of License:
*
Operator
Commercial (CDL)
Chauffeur
Have you had any accidents during the past three year?
How many?
*
Have you had any moving violations during the past three years?
How many?
*
SECTION B: BACKGROUND INFORMATION
TYPE OF SCHOOL AND NAME OF SCHOOL
*
LOCATION (Complete mailing address)
*
NUMBER OF YEARS COMPLETED
*
MAJOR & DEGREE
*
TYPE OF SCHOOL AND NAME OF SCHOOL
*
LOCATION (Complete mailing address)
*
NUMBER OF YEARS COMPLETED
*
MAJOR & DEGREE
*
TYPE OF SCHOOL AND NAME OF SCHOOL
*
LOCATION (Complete mailing address)
*
NUMBER OF YEARS COMPLETED
*
MAJOR & DEGREE
*
TYPE OF SCHOOL AND NAME OF SCHOOL
*
LOCATION (Complete mailing address)
*
NUMBER OF YEARS COMPLETED
*
MAJOR & DEGREE
*
Certifications: Please check all that apply and list expiration date:
CRP
CRP
CRP Exp.
First Aid
First Aid
First Aid Exp.
OSHA10
OSHA10
OSHA10 Exp.
OSHA30
OSHA30
OSHA30 Exp.
Respirator
Respirator
Respirator Exp.
Fork Lift
Fork Lift
Fork Lift Exp.
Scissor Lift
Scissor Lift
Scissor Lift Exp.
Hand Tools
Hand Tools
Hand Tools Exp.
List Additional Certifications:
Ethnicity
*
Black
Oriental
Hispanic
American Indian
White
Other
DO YOU HAVE ANY PHYSICAL OR MENTAL DISABILITIES OR HANDICAPS WHICH MAY NOT ALLOW YOU TO PERFORM THE BASIC JOB REQUIREMENTS AT TASK? (standing/sitting/kneeling/bending/pushing/pulling/twisting/walking/climbing/grasp/squeeze/reaching/lifting/keyboarding etc.)
*
Yes
No
If yes, please list and give reason
HAVE YOU EVER BEEN IN THE ARMED FORCES?
*
Yes
No
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?
*
Yes
No
Specialty
Date Entered
Discharge Date
SECTION C: WORK EXPERIENCE
Please list your work experience for the past 5 years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary
Name of employer
*
Name of last supervisor
*
Employment date From-To
*
Pay or salary Start-Final
*
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Your last job title
*
Reason for leaving (be specific)
*
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you work at this company.
*
Name of employer
Name of last supervisor
Employment date From-To
Pay or salary Start-Final
Address
City
State
Zip Code
Phone Number
Your last job title
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you work at this company.
May we contact your present employer?
*
Yes
No
Did you complete this application yourself?
*
Yes
No
If not, who did?
Please list two references other than relatives or previous employers.
Name
*
Name
*
Relation:
*
Relation:
*
Address
*
Address
*
Telephone
*
Telephone
*
APPLICATION FORM WAIVER
In exchange for the consideration of my job application by CIPPCO (hereinafter called “the Company"), I agree that:
Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefits plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of CIPPCO, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both the undersigned and CIPPCO may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.
I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.
I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.
I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.
Print Employee Name
*
Signature of applicant
*
Date
*
MM slash DD slash YYYY
This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.
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