Employment Application

Work Experience

Please list the names of your present and/or previous employers in descending chronological order, starting with your most recent or current employer. Account for all periods of time including any period of unemployment. If self-employed, supply business references.

Employer #

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Employer Name

Business Type

Phone Number

Business Address

City

State

Zip

Employed From / Until

Job Title

Duties / Responsibilities

Supervisor Name

Yes

Supervisor can be contacted Reason to not contact supervisor

Reasons for leaving position

Employer Name*

Business Type*

Phone Number*

Business Address*

City*

State*

Zip*

Dates Employed*

From

Job Title*

Duties / Responsibilities*

Supervisor Name*

May we contact this person?*
Yes No

Why not?*

What were your reasons for leaving this position?*

Add another employer

Please explain all gaps in your employment history.

Summarize any special training, skills, licenses and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.

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Education

List the last three schools you attended, starting with the most recent. List the number of years you completed at each school.

School #

School Name

Years Completed

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Welding Skills and Capabilities

If you are applying for a welder position, please list your welding skills and capabilities.

Welding Process*

Aggregate years experience*

Include the total years you've used this process over the positions held.

Positions*

× Remove Experience

Add another process

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References

Please list the names of any additional work-related references we may contact.

Name*

Work Relationship*

Phone Number*

Company*

Position*

× Remove Reference

Add another reference

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Background Notice

Notice Regarding Background Investigation

Q.B. Johnson Manufacturing, Inc., may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, driving record, and/or mode of living, and which can involve personal interviews with sources such as your current and past employers, friends, or associates, as well s past employment information in compliance with regulations of the U.S. Department of Transportation (DOT), including 49 CFR Part 40 and 49 CFR Part 382, regarding DOT drug and alcohol testing results from past employers.

These reports may be obtained at any time after receipt of your authorization and, if you are hired, throughout your employment.

You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of the most common form of consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by

PreHire Screening Services LLC
1201 Sovereign Row
Oklahoma City, OK 73108
1-(866) 405-4473

The scope of this notice and authorization is all-encompassing, however, allowing Q.B. Johnson Manufacturing, Inc. to obtain from any outside organization all manner of consumer reports and investigative consumer reports now, and if you are hired, throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

The following is for identification only to perform the background check and will not be used for another purpose.

Legal Name or Authorizing Consumer*

Date of Birth*

Additional Needs

You will be required to provide your Social Security Number and Current Drivers License at a later date.

Other names you've been known by

Including Maiden/Married Name(s)

Current Address* Current Address Line 2

City*

State*

Zip*

Please list any previous addresses over the past 7 years

Address* Address Line 2

City*

State*

Zip*

× Remove Address

Add another address

Oklahoma Applicants

Oklahoma applicants have the right to request a copy of any credit report requested during their background checks.

Yes, I would like to receive a copy of any requested credit reports.

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Applicant Certification

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver's license.
I understand that the Company has a drug-free workplace and drug testing program consistent with applicable federal, state, and local law and agree to work under these conditions. If offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug test is positive, the employment offer may be withdrawn.

I also understand that all employees of the locations, pursuant to the Company's policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of illegal or controlled drugs.

If employed, I understand that the taking of drug tests is a condition of continual employment and I agree to undergo drug testing consistent with the Company's policies.
I certify that all the information on this application, my résumé, or any supporting documents I may present during an interview is and will be completed and accurate tot he best of my knowledge. I understand that the falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment, or employed, disciplinary action up to and including immediate dismissal.
I authorize the Company or its agents to confirm all statements contained in this application and/or résumé as it relates tot he position I am seeking and to the extent permitted by federal, state, or local law.
If hired by this company, I understand that I will be required to provide a genuine documentation establishing my identify and eligibility to be legally employed in the United States and by this Company.

I understand and agree to the terms outlined above.*

I certify that the information I provided on this application is true, accurate, and complete to the best of my knowledge.*

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Please note, this application will be considered active for a maximum of sixty (60) days. If you wish to be considered for employment after that time, you must reapply.