Employment Application | Enerbase

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Petroleum
Propane
Machinery/Parts
Lubricants
Agronomy LLC
Car Care
Hardware

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About Us
Locations
Petroleum
Propane
Machinery/Parts
Lubricants
Agronomy LLC
Car Care
Hardware

Applicant Information

Name *

First

Middle

Last

List any previous names you have gone by

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Date Available *

Desired Shift

Desired Salary *

Position applied for *

Are you a citizen of the United States? *

Yes
No

If no, are you authorized to work in the U.S? *

Yes
No

Have you ever worked for this company? *

Yes
No

If so, when?

Have you ever been convicted of a crime? *

Yes
No

If yes, explain

Education

High School

High School Address

From

To

Did you Graduate High school?

Yes
No

High School Degree

College

College Address

From

To

Did you Graduate College?

Yes
No

College Degree

Other Education

Other Education Address

From

To

Did you Graduate?

Yes
No

Other Degree

References

Please list two professional references, and one personal reference.

Name *

First

Last

Relationship *

Company *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name *

First

Last

Relationship *

Company *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Name *

First

Last

Relationship *

Company *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Previous Employment

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

Yes
No

Military Service

Branch

From

To

Rank of Discharge

Type of Discharge

If other than honorable, explain

Disclaimer and Signature

Checkboxes *

I agree to the below terms

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Select Current Date / Time *

Date

Time

Equal Employment Opportunity Form

Applicant Information

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Position Applied For *

Voluntary Information

This information is being requested in accordance with federal regulations. The information is voluntary and will not be used when considering you for employment with our company.

Racial or Ethnic Group

American Indian/Alaskan
Asian
Black/African American
Hispanic/Latino
Native Hawaiian or Pacific Islander
White/Caucasian
Two or More Races

Gender

Male
Female

Military Service

Pre-Vietnam Era
Vietnam Era
Post-Vietnam Era
Disabled Veteran

How did you hear about this position?

Newspaper
Job Fair
Company Employee
Placement Officer
Professional Publication
Website
Other

Other

Email

205 46th Ave NE

701-852-2501

Blue Creative