West Coast Pipe Application for Employment

Pre-employment Questionnaire
(An equal opportunity employer)

PERSONAL INFOMATION

Date: Social Security Number:
  Last First Middle
Name:
Present Address:    
City: State: ÊÊZip:
Permanent Address:    
City: State: ÊÊZip:
Phone Number: ÊÊÊÊE-Mail:

Are you 18 years or older? Ê Yes    No

EMPLOYMENT DESIRED

Position desired:
What date can you start?
Salary Desired:
Are you Employed Now?  Yes    No
If so may we inquire of your present employer?  Yes    No
Have you ever applied to West Coast Pipe Before?  Yes    No
Where?
When?
Referred by:

EDUCATION     

  Name and
Location of School		 No. of Years
Attended 		 Did you
Graduate?		 Subjects Studied
Grammar School
High School
College
Trade, Business or
Correspondence School

GENERAL         

Please list any special skills or abilities that pertain to the position for which you are applying:

Activities: (Civic, Athletic, etc.)
(Exclude organizations, the name of which indicates the race, creed, sex, age, marital status, color or nation of origin of its members)

U.S. Military or Naval Service:
Rank:
Present Membership in
National Guard or Reserves:

FORMER EMPLOYERS (List your last three employers below, starting with the last one first)

DATES
(month & year) 		Name & Address
of Employer 
Salary		 Position Reason
for Leaving
From: To:
From: To:
From: To:

Which of these jobs did you like best?

What did you like most about this job?

REFERENCES: Give the names of three persons not related to you, whom you have known at least one (1) year.

  Name Address Business   Years Acquainted
1.
2.
3.

ÒI CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED, MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO WEST COAST PIPEÕS RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR WEST COAST PIPEÕS OPTION.  I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY WEST COAST PIPE.  I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN ITÕS PRESIDENT, AND THEN ONLY WHEN IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.Ó

I AGREE TO THESE TERMS AND CONDITIONS

Full Name:   ÊÊDATE:


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