BP Job Application Form Name Job Applying For Title Choose One Mr. Ms. Mrs. Prof. Dr. First Name * Last Name * Email Address * Street Address * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Contact Number * If Related To Anyone at JPS, State Name Referred By Grammer School Grammer School Name And Location Grammer School Certificate or Degree Did You Graduate Grammer School? Yes No High School High School Name And Location High School Certificate or Degree Did You Graduate High School? Yes No College College Name And Location College Certificate or Degree Did You Graduate College? Yes No Trade, Business, Correspondence School Trade, Business, Cor. School Name And Location Trade, Business, Cor. School Certificate or Degree Did You Graduate Trade, Business, Cor. School? Yes No Subjects of Special Study Activities (Civic, Athletic, Professional) Apprenticeship or Internship What Trade of Program (List Dates, Number of Hours Served on the Job, Classroom Hours) Additional Training, Experience, and/or Equipment or Machinery you are proficient with * Name of Former Employer A * Start Date Employer A * End Date Employer A * Title or Duties of Employer A * Rate of Pay at Employer A * Reason for Leaving Employer A * Name of Former Employer B Start Date Employer B End Date Employer B Title or Duties of Employer B Rate of Pay at Employer B Reason for Leaving Employer B Name of Former Employer C Start Date Employer C End Date Employer C Title or Duties of Employer C Rate of Pay at Employer C Reason for Leaving Employer C Name of Former Employer D Start Date Employer D End Date Employer D Title or Duties of Employer D Rate of Pay at Employer D Reason for Leaving Employer D May We Contact Your Current Employer? Yes No Explain Please provide 3 References not related to you, whom you have known for at least one year. Type of Driver's License You Hold Regular CDL Has your Driver's License Been Revoked or Suspended in the last 3 years? Yes No If Yes, Explain Any Restrictions on your License? Yes No Is Yes, Explain Issuing State - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Expiration Date Driver's License No. How many years have you been driving? Less than 1 Year 2-3 Years Over 3 Years Did you have any moving traffic violations or accidents in the last 3 years? No Yes Is Yes, please detail Month, Year, Description of Violation (Not Parking) and/or Accidents Any objection to Saturday work? Any objection to travel, if required by job? Objection to overtime? If hired, could you give written evidence of a right to work in the country? If you are a member of any union, name them Please list any physical defects which would prevent you from performing the position applied for. In Case of Emergency Notify: (Name, Address, Telephone) I have read and understand the following: I authorize investigation of all statements contained in this application I understand that misrepresentation or omission of facts called for is cause for dismissal, further I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without previous notice. Any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of or if employed termination from employment. It is by understanding that the company will make a thorough investigation of my entire work and personal history and may verify all data given in my application for employment related papers or oral interviews . I authorize such investigation and the giving and receiving of any information requested by the company and I release from liability any person giving or receiving any such information . I understand that falsification of data so given or other derogatory information discovered as a result of this investigation may prevent my being hired or if hired may subject me to immediate dismissal. I agree that my employment may be terminated by this company at any time without liability for wages or salary except such as may have been earned at the date of such termination. I understand and agree that I may be required to take a physical examination at company expense at any time to determine if I am physically fit for the job I am to perform and I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the duties of a job I am being considered for prior to employment or in the future during my employment with the company. I further understand that this is an application for employment and that no employment contract is being offered. Notice to applicants & employees: Screening tests for alcohol and illegal drug use may be required before and during your employment here. It is understood that employment with this company is temporary. Employment is for the duration of a project, until weather no longer permits construction or lack of work results in termination. * Information Summary
