Specialty Rigging Co. Online Application Step 1 of 5 20% Applicant InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Date Available* Social Security* Desired Salary* Are you a citizen of the United States?* Yes No If no, are you authorized to work in the U.S.? Yes No Are you currently employed?* Yes No If so, may we contact your current employer? Yes No Have you ever worked for this company?* Yes No If so, when? Have you ever been convicted of a felony? Yes No If yes, explain Previous EmploymentCompany Name Company Address Company Supervisor Company PhoneJob Title Starting Salary Ending Salary ResponsibilitiesFrom To Reason for Leaving Company Name Company Address Company Supervisor Company PhoneJob Title Starting Salary Ending Salary ResponsibilitiesFrom To Reason for Leaving Company Name Company Address Company Supervisor Company PhoneJob Title Starting Salary Ending Salary ResponsibilitiesFrom To Reason for Leaving High School EducationHigh School Name High School Address From To Did You Graduate? Yes No Degree College EducationCollege Name College Address From To Did You Graduate? Yes No Degree Other EducationSchool Name School Address From To Did You Graduate? Yes No Degree ReferencesPlease list three professional references.Full Name Relationship Company PhoneAddress Full Name Relationship Company PhoneAddress Full Name Relationship Company PhoneAddress General QuestionsAre you capable of lifting 100lbs?* Yes No Can you work overtime as required?* Yes No Do you currently or have you ever had a neck injury?* Yes No If so, explain: Do you currently or have you ever had a back injury?* Yes No If so, explain: Do you currently or have you ever had a shoulder injury?* Yes No If so, explain: Special Skills (ex: CDL Drivers License, Welding, etc.)List all here.Disclaimer and SignatureI 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.Signature* Date* Δ
