Error: Contact form not found. 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? -- Select Position -- Senior Estimator Superintendent Foreman Operator Pipelayer Pipelayer Helper Project Manager Human Resources Dept Project Coordinator Estimator Other If referred, by whom? Distance willing to commute one way? Have you ever applied with Delta Pipeline? Yes No If yes, list date(s) and job title(s) Have you ever been employed by Delta Pipeline? Yes No If yes, list date(s) and job title(s) Do you have any relatives employed by Delta Pipeline? Yes No If yes, list name(s) and job title(s) Are you at least 18 years or older? Yes No If under 18 years old, do you have a work permit? Yes No 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 If hired, can you provide proof of authorization to work in the United States? Yes No Do you possess a valid driver’s license and auto insurance? Yes No Do you have a reliable form of transportation to and from work? Yes No If hired, are you able to submit to a pre-employment drug screen? Yes No Are you able to work nights, weekends, and overtime as required? Yes No Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation(s)? Yes No May we contact your current employer for references? Yes No May we contact your previous employer(s) for references? Yes No 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. PLEASE ACKNOWLEDGE:* Yes, Accepted No, Not Accepted Submit
