Employment Application

We are an equal opportunity Employer

Position Applied For:

Date of Application:

Name:

Last

First

Middle

Address:

Street

City

State

Zip

Phone:

Cell:

Fax:

Date Available to Start:

Social Security Number:

Type of Employment Desired:

Full-Time

Part-Time

Temporary

Have You Ever Been Convicted of a Felony?

YES

NO

If Yes, Please Explain:

Outstanding Warrants?

If Yes, Explain:

Any Reason Why You Wouldn't Be Eligible To Get A CDL License? If Yes, Explain:

Education? High School Diploma or GED

College?

Years?

Have You Ever Been Employed Here Before?

YES

NO

Are You Legally Eligible for Employment in This Country?

YES

NO

Personal References:

Name

Address

City

State

Phone

How Long Have They Known You?

Name

Address

City

State

Phone

How Long Have They Known You?

Elite Wireline, Inc.

Page 2

Employment Application

We are an equal opportunity Employer

Work Experience

From

To

Employer

Phone

Job Title

Address

Immediate Supervisor

Nature of Work and Responsibilities

Nature of Work (Continued)

Hourly Rate When You Left

Reason for Leaving

From

To

Employer

Phone

Job Title

Address

Immediate Supervisor

Nature of Work and Responsibilities

Nature of Work (Continued)

Hourly Rate When You Left

Reason for Leaving

From

To

Employer

Phone

Job Title

Address

Immediate Supervisor

Nature of Work and Responsibilities

Hourly Rate When You Left

Reason for Leaving

I certify That All Information Provided Above is Correct

Signature:

Date: