Personal Information

First Name *
Middle Initial *
Last Name *
Street Address *
City *
State *
Zip Code *(Numbers only)

CELL PHONE (FORMAT: 123-456-7890) *
Alternative Phone (FORMAT: 123-456-7890)
Email Address *
How did you hear about us?

If referred, by whom?
Distance willing to commute one way?

Have you ever applied with Delta Pipeline?

If yes, list date(s) and job title(s)

Have you ever been employed by Delta Pipeline?

If yes, list date(s) and job title(s)

Do you have any relatives employed by Delta Pipeline?

If yes, list name(s) and job title(s)

Are you at least 18 years or older?

If under 18 years old, do you have a work permit?

Available Start Date
Desired Pay

High School Education

High School Name

High School Address
City
State
Zip Code(Numbers only)

Major Studies
Highest Grade Completed
List any Degree(s), Diploma(s), License(s) or Certificate(s)

Vocational, Trade, Business or Other Non-College Education

School Name(s)

Major Studies
Years of Study (Numbers only)

List any Degree(s), Diploma(s), License(s) or Certificate(s)

List any Professional Designations
Other Special Knowledge, Skills or Qualifications
Computer Skills

College/University Education

School Name(s)
Major Studies

Years of Undergraduate Study (Numbers only)
Years of Graduate Study (Numbers only)

List any Degree(s), Diploma(s), License(s) or Certificate(s)
List any Professional Designations

Other Special Knowledge, Skills or Qualifications
Computer Skills

Employment History

List all employment history for the past 5 years, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.


Employment 1

Employer | Company Name
Supervisor Name
Supervisor Phone Number (FORMAT: 123-456-7890)
Address
City
State
Zip Code (Numbers only)

Job Title
Employment Start Date
Employment End Date
Duties and Responsibilities
Reason for Leaving

Employment 2

Employer | Company Name
Supervisor Name
Supervisor Phone Number (FORMAT: 123-456-7890)
Address
City
State
Zip Code (Numbers only)

Job Title
Employment Start Date
Employment End Date
Duties and Responsibilities
Reason for Leaving

Employment 3

Employer | Company Name
Supervisor Name
Supervisor Phone Number (FORMAT: 123-456-7890)
Address
City
State
Zip Code (Numbers only)

Job Title
Employment Start Date
Employment End Date
Duties and Responsibilities
Reason for Leaving

Explanation for all employment gaps

List 3 persons not related to you who have knowledge of your work performance within the last 5 years.

References

Name
Contact Phone Number (FORMAT: 123-456-78)

Name
Contact Phone Number (FORMAT: 123-456-78)

Name
Contact Phone Number (FORMAT: 123-456-78)

General

Please Acknowledge Below

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Delta Pipeline, Inc. to thoroughly investigate my references, work record, education and other matters related to my suitability for employment (excluding criminal background information) unless otherwise specified above. I further authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local "Fair Chance" laws.

Personal Information

First Name *
Middle Initial
Last Name *
Street Address *
City *
State *
Zip Code *(Numbers only)
CELL PHONE (FORMAT: 123-456-7890) *
Alternative Phone (FORMAT: 123-456-7890)
Email Address *
How did you hear about us?
If referred, by whom?
Distance willing to commute one way?
If yes, list date(s) and job title(s)
If yes, list date(s) and job title(s)
If yes, list name(s) and job title(s)
Available Start Date
Desired Pay

High School Education

High School Name
High School Address
City
State
Zip Code(Numbers only)
Major Studies
Highest Grade Completed
List any Degree(s), Diploma(s), License(s) or Certificate(s)

Vocational, Trade, Business or Other Non-College Education

School Name(s)
Major Studies
Years of Study (Numbers only)
List any Degree(s), Diploma(s), License(s) or Certificate(s)
List any Professional Designations
Other Special Knowledge, Skills or Qualifications
Computer Skills

College/University Education

School Name(s)
Major Studies
Years of Undergraduate Study (Numbers only)
Years of Graduate Study (Numbers only)
List any Degree(s), Diploma(s), License(s) or Certificate(s)
List any Professional Designations
Other Special Knowledge, Skills or Qualifications
Computer Skills

Employment History

List all employment history for the past 5 years, starting with the most recent position. All information must be completed. You may attach a resume, but not in place of completing the required information.


Employment 1

Employer | Company Name
Supervisor Name
Supervisor Phone Number (FORMAT: 123-456-7890)
Address
City
State
Zip Code (Numbers only)
Job Title
Employment Start Date
Employment End Date
Duties and Responsibilities
Reason for Leaving

Employment 2

Employer | Company Name
Supervisor Name
Supervisor Phone Number (FORMAT: 123-456-7890)
Address
City
State
Zip Code (Numbers only)
Job Title
Employment Start Date
Employment End Date
Duties and Responsibilities
Reason for Leaving

Employment 3

Employer | Company Name
Supervisor Name
Supervisor Phone Number (FORMAT: 123-456-7890)
Address
City
State
Zip Code (Numbers only)
Job Title
Employment Start Date
Employment End Date
Duties and Responsibilities
Reason for Leaving
Explanation for all employment gaps

List 3 persons not related to you who have knowledge of your work performance within the last 5 years.

References

Name
Contact Phone Number (FORMAT: 123-456-7890)
Name
Contact Phone Number (FORMAT: 123-456-7890)
Name
Contact Phone Number (FORMAT: 123-456-7890)

General

Please Acknowledge Below

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize Delta Pipeline, Inc. to thoroughly investigate my references, work record, education and other matters related to my suitability for employment (excluding criminal background information) unless otherwise specified above. I further authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that nothing contained in the application or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the Company's designated representative.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

The Company will consider qualified applicants, including those with criminal histories, in a manner consistent with state and local "Fair Chance" laws.