Bay State Piping Company, Inc.

Pipeline Construction

467 Wareham Street - Middleboro, Massachusetts  02346

Phone (508) 923-6022  Fax (508) 923-6023

 

Application For Employment

Pre-Employment Questionnaire

Bay State Piping Co., Inc. is an Equal Opportunity Employer

 

* Required Fields

Personal Information
Last Name *
First Name *
Middle Initial
Street Address *
City *
State/Region *
Zip Code * -
Phone Number * () -  Special Instructions
Email Address
Fax Number

Employment Desired
Position Applying For *

(check all that apply)
Foreman, Telecommunications Operator, Directional Drill
Foreman, Natural Gas Distribution Operator, Backhoe/Loader
Foreman, Water Works Operator, Trencher
Foreman, Trenchless Installations Operator, Excavator
Locator, Directional Drilling Truck Driver
Laborer, Telecommunications Weldor
Laborer, Natural Gas Distribution Weldor's Helper
Laborer, Water Works Administrative
Other (please specify) 
Date You Could Start *
Salary / Hourly Wage Desired *
Yes No
Are you over the age of 18? *
Have you been employed at Bay State Piping before? *

Are you legally eligible for employment in this country?  *

(proof of U.S. citizenship or immigration status will be required upon employment)

Have you ever been convicted of a crime, other than a minor traffic offense, including driving while under the influence of alcohol or drugs?  *

(NOTE:  Such conviction may be relevant if job related, but does not bar you from employment)

If yes, please explain:

(NOTE: Such conviction may be relevant if job related, but does not bar you from employment)
How were you referred to Bay State Piping and/or this position?

Education

Name and Location

Years

Completed

Did You Graduate?

Course(s) of Study
High School Yes No

Address
College Yes No

Address
Other Yes No

Address

Other Schooling/Experience
Driver's License Number *
Expiration Date *    State *  
Type of License * Class *
Massachusetts D.P.S. Hydraulic License?
Other License: 

United States Military or Naval Service (Branch, Dates, Rank, Special Training)

Other Activities/Schooling/Experience/Training

Exclude religious activities

Exclude organizations, the name or character of which indicates the race, creed, color or national origin of its members

Employment History
Please enter your last two (2) employers, starting with the last one first (you may include volunteer positions)

(1)

Hire Date *

End Date *

Employer *
Address *
Telephone *
Position *
Supervisor & Title *
Work Performed *
Hourly Rate/Salary *
Reason for Leaving *

(2)

Hire Date *

End Date *

Employer *
Address *
Telephone *
Position *
Supervisor & Title *
Work Performed *
Hourly Rate/Salary *
Reason for Leaving *

References
Please provide the names of persons not related to you whom you have known for at least one year.

Name

Telephone

Business

Years

Known
* * *
* * *
* * *

Authorization
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I understand that employment is on an at-will basis, and that I am free to resign or be terminated at any time.  In addition, I understand that this application or other personnel documents which are signed by me, do not constitute an employment contract.

I Accept
I Disagree