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Employment Application
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What We Do
Our Services
Project Management
Cathodic Protection Installation
Technical Service
Integrity Assessment Surveys
Integrity Construction Solutions
Inspection Services
Safety & Operator Qualification
Contact Us
Employment Application
Step
1
of
4
- Personal Information
0%
Pipeline Integrity Resources, Inc. Employment Application
Pipeline Integrity Resources, Inc. is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion or religious creed, disability, national origin, ancestry, gender, veteran status or any other characteristics protected under Federal or State Law.
Personal Information
Name
*
First
Middle
Last
Have you ever worked under another name?
*
Yes
No
Other Name you worked under?
First
Last
Date of Application
*
MM slash DD slash YYYY
Present Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is your Permanent Address different from your Present Address?
*
Yes
No
Permanent Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Type of work you are applying for?
*
Construction
Technical
Survey
Administration
Internship
Date Available to Work
*
MM slash DD slash YYYY
Position Applying For
Salary Requirements
Email
*
Attach Resume
Accepted file types: pdf, doc, docx, rtf, txt, Max. file size: 50 MB.
File types allowed - pdf, doc, docx, rtf, txt
General Information
Have you ever filed an application with us before?
*
Yes
No
Date of your first application
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1920
If you are under 18 years of age, can you provide required proof of your eligibility to work?
*
Yes
No
Have you ever been employed with us before?
*
Yes
No
Date when you used to work with us
Month
1
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Are you currently employed?
*
Yes
No
May we contact your present employer?
*
Yes
No
Are you currently on "lay-off" status and subject to recall?
*
Yes
No
Can you travel if a job requires it?
*
Yes
No
If applicable, are you willing to relocate?
*
Yes
No
Are any relatives employed with us?
*
Yes
No
Name of Relative?
First
Last
Training & Skills
Special training, skills (such as machinery, typing, word processing, language skills, etc.) or experiences related to the position applied for which you feel may especially quality you for work with our company:
Education & History
Name
Location / Telephone
Course
Graduate
Degree
Work Experience (Most Recent)
Name of Employer
Address of Employer
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Telephone of Employer
Supervisor's Name and Title
Position or Title
Reason for Leaving
Description of Duties
Date you Started
Month
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Last day you were employed
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1921
1920
Starting Pay
Ending Pay
Next Previous Employer
Name of Employer
Address of Employer
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Telephone of Employer
Supervisor's Name and Title
Position or Title
Reason for Leaving
Description of Duties
Date you Started
Month
1
2
3
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5
6
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10
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12
Day
1
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1922
1921
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Last day you were employed
Month
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Day
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1930
1929
1928
1927
1926
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1924
1923
1922
1921
1920
Starting Pay
Ending Pay
Next Previous Employer
Name of Employer
Address of Employer
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Telephone of Employer
Supervisor's Name and Title
Position or Title
Reason for Leaving
Description of Duties
Date you Started
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
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Last day you were employed
Month
1
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Starting Pay
Ending Pay
Driving Experience
If NO Driving Experience in the last 3 years, check here.
No driving experience
CDL
Class A CDL
Class B CDL
Endoresements
Air Brakes
Tanker
Combination
Hazmat
Medical Examiners Card
Current Medical Examiners Card
Accident History
If NO Accident History in the last 3 years, check here.
No Accident History
Accident History
Date (Month / Year)
Nature of Accident (Head-on, Rear-End, Etc.)
Number of Fatalities
Number of Injuries
Traffic Convictions and Forfeitures (3 years)
If NO Traffic Convictions and/or Forfeitures in the last 3 years, check here.
No Convictions or Forfeitures
Convictions / Forfeitures
Date of Convicted (Month/Year)
Violation (Other than Violations Involving Parking Only)
State of Violation
Penalty
Business References
References (Provide 3-4)
Contact Name
Company
Address
Telephone Number
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