Application | C3 Industrial

Personal History

Name*

First Last

Social Security Number*

Present Address*

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

Phone*

Position Desired*

Salary Desired*

Do you have legal right to work in the United States?*

Be prepared to provide valid documentation

Yes
No

Have you worked for the company before?*

Yes
No

If yes, give dates employed*

Driving Record

Do you have a driver's license?*

Yes
No

License Number & Type*

Expiration Date*

State Issued*

Copy of ID

Conviction Record

Have you ever been convicted of violating any law (except minor traffic violations)?*

Yes
No

If yes, please attach a summary of details. Disclosure of a criminal record does not automatically disqualify you from employment consideration.*

Employment History

Resume and/or Cover Letter*

Drop files here or

Are you currently employed?*

Yes
No

Can we contact your current employer?*

Yes
No

Have you ever been fired or asked to resign from a position?*

Yes
No

If yes, please explain*

Military Service

Are you a military veteran?*

Yes
No

Induction Date*

Date of discharge*

Branch*

Grade or rank*

Nature of duty or training*

Capabilities & Experience

Surface Prep*

Yes
No

Painting*

Yes
No

Blastings*

Yes
No

Coatings*

Yes
No

Please list all certifications below

Attach copies of certifications

Drop files here or

Notice to All Applicants

It is the policy of C3 INDUSTRIAL BLASTING & COATINGS, INC. (hereafter referred to as "the Company") to afford equal employment opportunity all qualified applicants and employees with regard to race, color, religion, national origin, sex (including pregnancy, childbirth or related medical conditions), age, disability, genetic information, past present or future status in the Uniformed Services of the United States of America or any other status or characteristic that is protected by federal, state or local law. I certify that the facts set forth in this application are true and complete to the best of my knowledge. I understand that falsification, misrepresentation, or omission of material information on this or any other employment form shall be grounds for immediate termination or denial of employment, regard of when such falsification, misrepresentation, or omission is discovered. I authorize the Company to investigate all statements contained in this application and hereby release former employers and the Company from any and all liability on account of furnishing such information to the Company. I understand that the Company will require applicants for employment to take an urinalysis and a breath alcohol screening as part of the selction process, and that any offer or employment with the Company is contingent upon the results of these tests being satisfactory. I understand that my employment may be terminated or I may resign at any time, with or without notice, with or without cause. I further acknowledge and agree that the period of my employment is indefinite and that neither 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 customary practices, shall serve to creat an inctual or implied contract of employment or to confer any right to remain an employee of the Company, or otherwise to change in any respect the employment-at-will relationship between me and the Company. The policy set forth in this paragraph may be modified only by written agreement signed by me and by an officer of the Company.

Signature*

Date*