Pirtek Jobs Application

NEWS: PIRTEK Kent at work for Coast Guard
PIRTEK Kent awarded subcontract with Todd Pacific Shipyards to complete required hose renewal for United States Coast Guard Polar Sea.

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CONNEXIONS ISSUE #29 NEWSLETTER: PIRTEK Sterling Heights Assists in the Production of Portable Modular Conveyors
PIRTEK Sterling Heights, owned by Eli Dorfman, is the third Center in the Detroit Metropolitan area and the newest location to the growing network of Hose Service Centers in the US. They recently contributed to the production of portable modular conveyors made by E2 Systems, LLC.

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Job Application

We consider applicants for all positions without regard to race, color, religion, creed, gender, national orgin, age, disability, marital or veteran status or any other legally protected status.

Position Applied For

Date Of Application

Location Applying for

Email Address

How did you learn about us?

Advertisement	Friend
Employment Agency	Relative

Last Name

First Name

Middle Name

Address

Apt.

City

State

Zip Code

Telephone Number(s)

Social Security Number

Best time to contact you at home is:
If you are under 18 years of age, can you provide proof of you eligibility to work?	Yes No
Have you ever filed an application with us before?	Yes No
If yes, give date
Have you ever been employed with us before?	Yes No
If yes, give date
Do any of your friends or relatives, other than spouse work here?	Yes No
If yes, state name, relationship and location
Are you currently employed?	Yes No
May we contact your current employer?	Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or immigration Status? Proof of citizenship or immigration status will be required upon employment.	Yes No
Date Available for work What is your desired salary range?
Are you available to work Part Time Full Time
Are you currently on "lay-off" status and subject to recall?	Yes No
Can you travel if a job requires it?	Yes No
Education

School	Name and Address of School	Course of Study	Years Completed	Dimploma/Degree
High School
Undergraduate College
Graduate/ Professional
Other

Work Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national orgin, disabilities or other protected status.

Employer

Telephone Number(s)

Starting/Present Job Title

Supervisor

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Work Performed

Reason for leaving
May we contact? Yes No

Employer

Telephone Number(s)

Starting/Present Job Title

Supervisor

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Work Performed

Reason for leaving
May we contact? Yes No

Employer

Telephone Number(s)

Starting/Present Job Title

Supervisor

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Work Performed

Reason for leaving
May we contact? Yes No

Employer

Telephone Number(s)

Starting/Present Job Title

Supervisor

Dates Employed
From	To

Hourly Rate/Salary
Starting	Final

Work Performed

Reason for leaving
May we contact? Yes No

Describe any specialized training, apprenticeship, skill and extra-curricular activities.

Describe any job-related training recieved in the United States military

List professional trade, business or civic activities and offices held.
You may exclude membership which would reveal gender, race, religion, national orgin, ancestry or other protected status.

Additional Information
Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills	Types of equipment worked on	Other
(Check all skills/equipment operated)	(Check all types worked on)	(list)
Hose Assembly Welding Soldering Lathe Work	Mechanical Road Transport Construction Material Handling Mobile Equipment

State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.
Are you capable of performing in a reasonable manner, with or without a reasonable accomodation, the activities involved in the job or occupation for whicn you have applied? A review of the activities involved in such a job or occupation has been given. Yes No

Personal/Professional References

Name	Phone Number	Best time to call	Occupation
1.
2.
3.

Do you have your own tools?	Yes No
Do you have everything in the minimum standard kit?	Yes No
Driving Record

License Number	Class
Please state any conviction in the last five years.

Applicant's Statement

I certify the answers given herein are true and complete.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at and employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the employer.

Signature of Application (Type in your name above)

Date