PAX INC. - Fabrication For The Future

Application for Employment

(Pre-Employment Questionnaire - An Equal Opportunity Employer)

Personal Information

Date Social Security Number

Last Name

First Name

Middle

Street Address

Apt#

City

State

Zip Code

Telephone Number

Referred By

Position

Date you can start

Salary Desired

Are you currently employed? Yes No If yes, may we inquire of your present employer? Yes No

Have you ever applied to this company before? Yes No

If yes, where?

When did you apply?

Have you ever pled "Guilty" or "No Contest" to or have been convicted of a crime? Yes No

If yes to the above question, Please provides date (s) and details.

Education History


	Grammar School	name, city & state of school

		Number of years attended
		Did you graduate? Yes No


	High School	high school / GED name, city & state of school

		Number of years attended
		Did you graduate? Yes No

	College	name, city and state of school

		Number of years attended
		Did you graduate? Yes No
		Areas of Emphasis / Degree Type

	Business/Trade/ Correspondence School	name, city and state of school

		Number of years attended
		Did you graduate? Yes No
		Areas of Emphasis / Degree Type

Special Skills

Activities (civic, athletic, etc.) EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.

U.S. Military or Naval Service

Rank

Present membership in National Guard or Services

Employment History (begin with the most recent position)


	Employer 1
	From To
	Employer name and phone number
	Salary
	Position
	Reason for leaving

	Employer 2
	From To
	Employer name and phone number
	Salary
	Position
	Reason for leaving

	Employer 3
	From To
	Employer name and phone number
	Salary
	Position
	Reason for leaving

	Employer 4
	From To
	Employer name and phone number
	Salary
	Position
	Reason for leaving

Which of these jobs did you like best?

What did you like most about this job?

References (Give the names of three persons not related to you, whom you have known for at least one year.)


	Reference 1
	Name
	Address or Phone Number
	Business
	Years Acquainted

	Reference 2
	Name
	Address or Phone Number
	Business
	Years Acquainted

	Reference 3
	Name
	Address or Phone Number
	Business
	Years Acquainted

In case of emergency notify

Name

Address

Phone Number

Other Number

If I am hired, I understand that I am free to resign at any time, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and with or
without prior notice, except as may be required by law. This applications does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of
the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.

I also understand that if I am hired, I will be required to provide proof of identity or legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) eliminate me from further consideration for employment, or (ii) may result in my
immediate discharge from the employer’s services, whenever it is discovered.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

Do you accept these terms? Yes No

pipe support fabrication | pipe rack modules | sub-assemblies | process modules / skids

39386 Babin Road Gonzales, LA 70737

(Voice) 225.644.6885 (Fax) 225.647.5268

info@paxfab.com