Employment Application

We appreciate your interest in Provenance Engineering. Please read all information before filling out and signing this application. Complete this application completely and accurately. Incomplete information could disqualify you from further consideration. Please advise us if you need assistance with completing this application form.

Provenance Engineering is an Equal Employment Opportunity employer. All applicants are considered for employment based upon their skills and abilities without regard to race, color, religion, gender, national origin, age, disability, marital status, sexual orientation, veteran status, or any other status protected by applicable federal, state or local law. As required by the Immigration Reform and Control Act, in the event you are hired, you must provide proof of eligibility to work in the United States upon employment.

Legal First Name

Legal Last Name

Street Address

City

State

Country

Postal Code

Phone *

Email *

Are you eligible to work in the U.S.?

Yes

No

Are you at least 18 years or older?

Yes

No

Have you ever been convicted of a felony or pled guilty or no contest?

Yes*

No

*a conviction will not necessarily bar you from employment

Have you previously worked for Provenance Engineering?

Yes

No

When did you work for Provenance Engineering?

Have you ever applied with Provenance Engineering before?

Yes

No

When did you apply to Provenance Engineering?

Are any of your relatives currently employed at Provenance Engineering?

Yes

No

Who is your relative?

How did you hear about us?

Position(s) Applying For

Days Available

Hours Available

Wage Expectations

Available for Overtime?

Yes

No

Is there any reason why you would be unable to perform the essential functions of this position without special accommodations?

Yes

No

ONLY answer if you have been provided with a copy of the job description and read what the essential functions are.

If required by the job, please state what languages you speak other than English:

Employment History

List all employers you have had for the past 7 years, beginning with your current or most recent employer. Use additional pages if necessary. Please explain any gaps in employment.

Employer 1 Name

Employer 1 Address

Employer 1 Phone

Employer 1 Supervisor Name and Title

Employer 1 Reason For Leaving

Employer 1 Start Date

Employer 1 End Date

Employer 1 Title

Employer 1 Ending Salary

2nd Most Recent Employer Details

Employer 2 Name

Employer 2 Address

Employer 2 Phone

Employer 2 Supervisor Name and Title

Employer 2 Reason for Leaving

Employer 2 Start Date

Employer 2 End Date

Employer 2 Title

Employer 2 Ending Salary

Education

Please provide the school name, City/State, Major Course of Study and Degree or Certificate earned.

Highschool

College

Trade School

Additional Skills Or Experience

Personal References

Please Provide Reference Name, Company, Phone Number and Years Known.

Reference 1

Reference 2

Reference 3

Additional Documents

Please attach any resumes, certificates or anything else you would like us to consider for your employment.

I hereby certify that the information I have provided in this application and in any documents I have submitted to Provenance Engineering in support of my application for employment, including resumes and transcripts, and/or information provided during the interview process, is complete and accurate to the best of my knowledge. I realize any falsification and/or misrepresentation or material omission of that information, stated or implied, may result in the denial of any employment offer, or the immediate termination of my employment if I am employed.

I also understand that employment with Provenance Engineering may be conditioned upon the completion of an Authorization for Release of Background Information and other employment documents as necessary, as determined by Provenance Engineering. In conjunction with the requirements of the federal Fair Credit Reporting Act and/or other applicable laws, I hereby authorize and consent to the investigation of all statements contained in this application and authorize all persons and companies named above and/or their agents to release any and all records and information pertaining to my employment history, police record, education background, military service, or personal reputation. Pursuant to applicable law I hereby release all parties from liability for damage for providing this information.

I understand that employment with Provenance Engineering is "at will." If I become employed by Provenance Engineering my employment and compensation are for no definite period and, regardless of the time and manner of payment of my wages, salary or other benefits, my employment and compensation can be terminated at any time, with or without cause and with or without notice at either the option of the Company or myself. I further understand that there are no other arrangements, agreements or understandings, oral or written, contrary to the foregoing and that the understanding set out herein supersedes any prior contrary statements. I further understand that any modification to this Certification and Acknowledgment will not be effective unless in writing and personally signed by a representative of Provenance Engineering having actual authority to approve such modification.

I understand that, if I am hired, I am required to abide by all of the Company’s rules, policies and procedures. I also understand that the Company’s rules, policies and procedures can and may be changed or modified at any time, with or without notice.

I have read or had read to me this release form and I understand, voluntarily consent, and agree to sign below.

Signature

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