Job Application Applicant Information Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Employment Position Which position are you applying to? * Directional Drill Operator Directional Drill Locator Heavy Equipment Operator Construction Laborer Construction Manager Small Cell Technician How did you hear about this position? If needed, are you available to work overtime? * Yes No On what date can you start working if hired? * MM DD YYYY Do you have reliable transport to and from work? * Yes No Hourly wage desired? $ Personal Information Have you ever applied to or worked for 5 Bars Services before? * Yes No If yes, when? MM DD YYYY Are you 18 years of age or older? * Yes No Are you a U.S. citizen or approved to work in the United States? * Yes No If hired, can you submit documentation verifying your identity and your legal right to work in the US within three business days? * Yes No Will you consent to a mandatory controlled substance test? * Yes No Job Skills/Qualifications Please list below the skills and qualifications you possess for the position for which you are applying: (Note: 5 Bars Services complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.) Please list any current certifications, such as OSHA training or CPR/First Aid Training that you possess: Do you currently have a valid Driver's License? * Yes No Do you have a Commercial Driver License (CDL) ? Yes No If Yes, which type of CDL do you have? A B C Education and Training High School: College/University: Vocational School/Specialized Training: Have you served in the military? Yes No If yes, do you possess any military skills that would be an asset for this position? Previous Employment Employer 1 Employer Name: Job Title: Supervisor Name: Employer Address: Address 1 Address 2 City State/Province Zip/Postal Code Country Employer Phone: (###) ### #### Date Employed: MM DD YYYY Date Departed: MM DD YYYY Reason for departure: Employer 2 Job Title: Supervisor Name: Employer Address: Address 1 Address 2 City State/Province Zip/Postal Code Country Employer Telephone: (###) ### #### Dates Employed: MM DD YYYY Date Departed: MM DD YYYY Reason for departure: Employer 3 Job Title: Supervisor Name: Employer Address: Address 1 Address 2 City State/Province Zip/Postal Code Country Dates Employed: MM DD YYYY Date Departed: MM DD YYYY Reason for departure: Reference Name: First Name Last Name Relationship: Phone (###) ### #### At-Will Employment The relationship between you and 5 Bars Services is referred to as "employment at will". This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or 5 Bars Services. No representative of 5 Bars Services has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive VicePresident/Chief Operations Officer or the Company's President. Applicant Signature: * Date * MM DD YYYY Thank you for your application!
