Employment Application Applicants may be tested for illegal substances Please enable JavaScript in your browser to complete this form.Date: *Name: *FirstLastAddress: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow long have you been at this address? *Date of Birth: *If under 18, please enter age:Email: *EmailConfirm EmailConfirm EmailPhone Number: *What position(s) are you interested in? *Salary desired: *Days available to work: *Any day / Any TimeMondayTuesdayWednesdayThursdayFridaySaturdaySundayTimes on checked days that you are not available?Employment Desired: *Full-TimePart-TimeFull or Part-TimeEducationHigh School / GED: *School Address / Phone #:Degree: *College / Trade School:School Address / Phone #:Degree / Major: Certifications:Any other education you would like to add? *YesNoAny other education you would like to add?MilitaryHave you ever been in the Armed Forces? *YesNoBranch & Specialty: *Date Entered: *Date Discharged: *Previous ExperiencePlease list work experience for last five years, beginning with most recent job held.Company Name:Company Address and Phone Number:Supervisor Name:Position Held:Date that employment was started:Date employment ended:Reason for leaving?Enter N/A if still employedList Jobs and duties performed, skills used and learned and any advancements or promotions while employed:Do you have any more employment to add? *YesNoCompany Name:Company Address and Phone Number: Supervisor Name:Position Held:Date that employment was started: Date employment ended: Reason for leaving? Enter N/A if still employedList Jobs and duties performed, skills used and learned and any advancements or promotions while employed: Do you have any more employment to add? *YesNoCompany Name:Company Address and Phone Number:Supervisor Name:Position Held:Date that employment was started:Date employment ended:Reason for leaving?Enter N/A if still employedList Jobs and duties performed, skills used and learned and any advancements or promotions while employed:May we contact your present employer? *YesNoReferencesPlease list two references other than relatives or previous employers.Name: *Relationship & How long have they known you: *Phone: *Name: *Relationship & How long have they known you: *Phone: *Do you have a driver's license? *YesNoWhat is your means of transportation for getting to work: *Do you own your own vehicle or does someone drive you?Driver's License #: *State of Issue: *Expiration Date: *Type of License: *Operator, CDL, etcAny accidents or moving violations in last 3 years? *Did you fill out the application yourself? *YesNoWho helped you? *Have you ever been convicted of a crime? *YesNoPlease explain the situation: *Additional InformationApplication forms sometimes make it difficult for someone to pass all the desired information on to potential employers. Please use the space below to put any additional information you feel we should know in regards to the application. What else can you tell us about you?Resumes and Cover LettersIf you have a cover letter or resume to send, please upload them here. Also, feel free to email them to kurt@highplainssystems.com and put Job Application CV and Resume in the subject. Thank you.Upload Resume: Click or drag a file to this area to upload. Upload Cover Letter: Click or drag a file to this area to upload. Submit
