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Twitter Title Choose One Mr. Ms. Mrs. Prof. Dr. First Name * Middle Name Last Name * Address Line 1 * Address Line 2 City * State / Province * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Contact Number * Alternate Contact Number * Email Address * Upload CV Add File Please upload your CV in PDF format. Emergency Contact Details : First Emergency Contact Emergency Contact First Name * Emergency Contact Last Name * Emergency Contact Phone Number * Second Emergency Contact Second Emergency Contact First Name * Second Emergency Contact Last Name * Secondary Emergency Contact Phone Number * Date Available For Employment * Do you speak any languages other than English? * Yes No How were you referred to us? * Internet Site Google Search Friend/Associate Other Please Specify Do you have a Philtek Services Recruiter? * Yes No Have you ever travel/been on contract before? * Yes No Can you, after employment, submit verification of your legal right to work in the United States? * Yes No Are you able to perform the essential functions of the position for which you are applying with or without reasonable accommodations? * Yes No Have you ever been convicted of a crime that would prohibit your employment? * Yes No Are you willing to submit to a criminal background investigation? * Yes No As a condition of employment, you may be required to take and pass a drug and/or alcohol screen in any or all of the following circumstances: pre-employment post-accident for cause random selection Education : School College or University * Major/Discipline * Degree * Yes No School College or University * Major/Discipline * Degree * Yes No School College or University * Major/Discipline * Degree * Yes No Work History List in order, most recent first. First Employer : Employment Start Date Employment End Date Employer Name Position Held Employer Address Line 1 Employer Address Line 2 Employer City Employer State/Province - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Employer ZIP Code Immediate supervisor Employer Phone Number May we contact? Yes No Second Employer : Employment Start Date Employment End Date Employer Name Position Held Employer Address Line 1 Employer Address Line 2 City State / Province - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Immediate supervisor Employer Phone Number May we contact? Yes No Philtek Services is an Equal Opportunity Employer. All applicants are considered for employment regardless of age, rage, gender, religion, national origin, disability, marital status, or any other factor prohibited by law. I certify that the information provided on this application is accurate. I understand that the withholding of information or the giving of false information on this application will result in a refusal to hire or disciplinary action up to and including termination. Furthermore, I grant permission to any person, firm, corporation, or educational institution to release to Philtek Services any and all information regarding my past employment, background, credit history, education, motor vehicle records, and criminal records. I or the company may terminate the employment relationship at any time, for any reason, with or without cause or notice. I also understand and agree that only an officer of the company can enter into an agreement on any other terms and he/she can only do so in writing signed by him/her and me. I have read the above before signing the application. I further understand and waive my right of privacy in this investigation and release and hold harmless Philtek Services and any of its agents from any liability. I agree that any decision to hire me is contingent upon the results of my report, and certify that all statements and answers on my application, resume, or interview are true and complete to the best of my knowledge. I understand that if any statements are false or that if the information has been omitted, this will cause disqualification and immediate termination of my employment. If employed, I further authorize Philtek Services to check my credit and conviction record, as needed, on a continuous basis as it relates to my employment. I authorize Philtek Services to release any employment records submitted to Philtek Services to any customer of Philtek Services for consideration of employment at the customer facility. * Required information for background check : Social Security Number * Date of Birth * Driver's license State Issued List any city and state that you’ve lived in for at least six months during the last seven years. Information Summary
