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SERVICING AMERICA'S ENERGY

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Construction
Fabrication Services
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Positions Applied For*
Location(s) Applied For
First Name*
Middle Name
Last Name*
Suffix (Jr, Sr, Etc)
Social Security*
No dashes in Social Security Number. Example 123456789
Mailing Address*
Mailing Apt/Lot #
Mailing City*
Mailing Zip Code*
Mailing State*
Check here if Mailing Address is the same as Physical Address
- Yes
Physical Address
Physical Apt/Lot #
Physical City
Physical State
Physical Zip
Email Address*
Phone*
Cell Phone
Are you under 18 years of age?*
- Yes
- No
If yes (under 18 years of age), can you provide a work permit?
- Yes
- No
If you cannot provide a work permit, why?
Have you ever been employed by Southeast Texas Industries/Southeast Texas Industrial Services?*
- Yes
- No
Are you legally eligible to work in the United States?*
- Yes
- No
Date available for work?*
Date Format: MM slash DD slash YYYY
Desired salary?
Type of employment desired:*
- Full Time
- Part Time
- Any available
Are you able to meet the requirements of the position you are applying for?
- Yes
- No
Are you presently employed?
- Yes
- No
If so, where?
How long?
Do you speak any foreign languages fluently?
- Yes
- No
If yes, what languages?
Have you ever been convicted or pleaded guilty to a felony*
*Answering yes to this question does not automatically disqualify you for employment. Factors such as the seriousness of the offense, the date and rehabilitation and position applied for will be taken into consideration.
- Yes
- No
If answering yes, please give date and details

EMPLOYMENT HISTORY
Provide the following information of your past employment, starting with the most recent employer.
Employer #1
Employer #1*
Start Date*
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Immediate Supervisor #1*
Beginning salary #1
Ending salary #1
Location #1
Telephone #1
Starting Job Title #1
Final Job Title #1
Job Duties #1
Reason for leaving #1
Employer #2
Employer #2
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Immediate Supervisor #2
Beginning salary #2
Ending salary #2
Location #2
Telephone #2
Starting Job Title #2
Final Job Title #2
Job Duties #2
Reason for leaving #2
Employer #3
Employer #3
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Immediate Supervisor #3
Beginning salary #3
Ending salary #3
Location #3
Telephone #3
Starting Job Title #3
Final Job Title #3
Job Duties #3
Reason for leaving #3
SKILLS AND QUALIFICATIONS
Summarize any training, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Safety training (ISTC/SETSA/NCCER/NCCO)
Do you have a TWIC Card?*
- Yes
- No
TWIC Card Expiration Date
Date Format: MM slash DD slash YYYY
Do you have an NCCER Certification?
- Yes
- No
NCCER Certification #*
Do you have an NCCCO Certification?
- Yes
- No
NCCCO Certification #*
EDUCATIONAL BACKGROUND
High School
Years completed
Did you graduate?
- Yes
- No
College
Years completed
Degree
Major
PERSONAL REFERENCES
Name three people not related to you, for personal references that you have known for at least one year.
Reference 1
Name #1*
Address #1*
Phone #1*
Years Known #1*
Business #1
Reference 2
Name #2
Address #2
Phone #2
Years Known #2
Business #2
Reference 3
Name #3
Address #3
Phone #3
Years Known #3
Business #3
Did you serve in the military?
- Yes
- No
If yes, what branch and dates of service?
EMERGENCY CONTACT INFORMATION
Name*
Relationship to applicant*
Phone Number
PERSONAL INFORMATION
SEX:*
- Male
- Female
Race*
- American Indian
- Asian
- Black/African American
- Hispanic/Latino
- Native Hawaiian/Pacific Islander
- Caucasian
- Two or More

APPLICATION STATEMENT
I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (1) cancel further consideration of this application, or (2) immediately discharge me from the employer's service, whenever it is discovered.

I expressly authorize, without reservation, the employer, it's representatives, employees or agents to contact and obtain information from all references (personal and professional), employees, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume' or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me.

I understand that the employer does not unlawfully discriminate in employment and no question in this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by application of local, state or federal law.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by the law. This application does not constitute an agreement or contract for employment for any specified period and that no implied, oral or written agreement is valid, unless they are in writing and signed by the employer's president.

I also understand that if I am hired, I will be required to pass a pre-employment drug screen and also provide proof of legal authority to work in the United States and that the federal immigration laws require me to complete an I-9 form in this regard.
PRE-EMPLOYMENT DRUG SCREENS
I understand that my employment with this company is subject to a pre-employment package which will include some or all of the following depending on the position for which I am hired. I also understand if any portion of my pre-employment screen is non-negative, I will not be considered eligible for employment with STI GROUP for one calendar year.
- Completed & signed application with accurate information
- Passing a comprehensive pre-employment drug screen and/or physical
- Industrial Safety Training Council qualifications
- Passing required craft testing
- Approval of references and past employment
- Final review of management
I understand that if I am hired, I may be selected for random drug screens at any time and would have to pass them to continue my employment with the company.
DO NOT CHECK UNTIL YOU HAVE READ THE ABOVE STATEMENT*
- I certify that I have read, fully understand and accept all terms of the foregoing application statement.
SIGNATURE
Name*
Date*
Date Format: MM slash DD slash YYYY
How did you hear about us?*
Resume (Optional)
Accepted file types: doc, docx, pdf, pages, txt, rtf.
Text Messages
- Allow STI Group to send me text messages