Employment Application - National Energy Services

* - Required fields

First Name *
Middle Name
Last Name *
Date *
Address *
City *
State*
Zip *

Home Phone Number
Cell Phone Number
Message Phone Number
E-mail Address

Do you have the right to work in the U. S.? *
Yes No

Do you have a valid driver's license? *
Yes No Driver's License Number State

Are you a veteran? *
Yes No

Have you ever been convicted of DUI or DWI? *
Yes No

If applying for a lighting technician or other electrical position, what level of electrical knowledge/experience do you possess?
Entry-level Mid-level Expert

Do you have any professional licenses/certifications?
Yes No If so, please explain:

How would you rate your knowledge of lighting and associated products?
None
Basic skills in relamping and ballast change-outs (Less than two years of experience)
Solid skills in relamping and ballast change-outs (Three to five years of experience)
Knowledgable in various lighting concepts, configurations and products.
Strong lighting skills/experience

Education

High School
Location
Graduate? Yes No GED? Yes No College
Location
Graduate? Yes No Years Completed:
Degree
Special Courses/Major Field

Other Training

Employment

Position for which you are applying
Expected Wage *
Can you travel? * Yes No Can you work various shifts? * Yes No

List special skills and equipment you can operate (e.g., heavy equipment, office machines)

List certifications and license numbers

Employment Record

List employment beginning with present job (include military experience)

Current Employer
City
State
Phone Number

Job Title
Start Date
End Date
Wages
Reason For Leaving

Duties

Employer
City
State
Phone Number

Job Title
Start Date
End Date
Wages
Reason For Leaving

Duties

Employer
City
State
Phone Number

Job Title
Start Date
End Date
Wages
Reason For Leaving

Duties

Employer
City
State
Phone Number

Job Title
Start Date
End Date
Wages
Reason For Leaving

Duties

May we contact your current employer? *
Yes No

Have you ever pleaded guilty or "no contest" to a crime before? (Answering yes to this question does not constitute an automatic bar to employment.) *
Yes No

If yes, please give date and details of each offense

Do you have any friends or relatives working for NES?
Yes No If so, who?

How did you hear about NES? *
Name of referral
Do you know of someone who has the type of experience that NES is seeking who could travel and be a part of our company?
Name
Phone

Name
Phone

Professional References

Please provide in chronological order three professional references of past supervisors only from the last 5 years of your work history or your last 3 positions. If we cannot call these individuals do not list their information; they are not references.

	Reference 1	Reference 2	Reference 3
Name of past supervisor
His/her title
Company where you both worked
Relationship to you
Number of years worked together
Company for whom he/she is currently working
Current phone number

* I certify that all of the information I have provided on this application is true and accurate to the best of my knowledge. I understand that if any such information is found to be false or misleading in any respect, I will be disqualified from consideration for employment or subject to immediate dismissal if I am already employed.

Applicant's Statement

I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at any time with or without notice, and the Company has the same right.

I understand that the Company reserves the right to require me to submit to a pre-employment drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law. I consent to the release of the results of any such test(s) to the Company.

I understand that the Company may investigate my driving record, my criminal record and my credit history, and that an investigative consumer report may be prepared whereby information is obtained through personal interviews with neighbors, friends and others with whom I am acquainted. This inquiry would include information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request with a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.

I further understand that the Company may contact my previous employers. I authorize those employers to disclose to the Company all records and other information pertinent to my employment with them, and I release them from liability for providing such information. I also authorize the Company to provide truthful information concerning my employment with it to my prospective employers and I agree to release the Company from liability for providing such information.

I certify that all of the information I provide to NES, both in writing and verbally, will be true and accurate. I understand that if any such information is found to be false or misleading in any respect, I will be disqualified from consideration for employment or subject to immediate dismissal if I am already employed.

* I certify that I have read and understand this statement.

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