Jobs – Mid-State Tank Co, Inc.

Desired Position*

Desired Salary

Hourly Rate (or equivalent)

Desired Availability*

Check any that apply

Full-Time
Part-Time
Temporary

Desired Start Date*

Desired End Date*

(For Temporary Availability only)

Are you willing to travel?*

Yes
No

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Enter Email Confirm Email

I am at least 18 years of age*

If no, then you will need to provide proof of work eligibility

Yes
No

Citizenship*

I am a legal citizen of the United States
I am NOT a legal citizen of the United States

Are you prevented from becoming lawfully employed?*

Due to Visa, Immigration Status or Other

Yes
No

Education Information

Education Levels Attained

Please check any that apply

G.E.D.
High School
Technical School
College

G.E.D. Information

G.E.D. Graduation State*

High School Information

High School Years Completed?*

Please enter a value between 1 and 5.

High School Name*

High School Address*

Street Address Address Line 2 City State ZIP Code

Additional High School Activities

Technical School Information

Certificate/Degree Acquired*

Technical School Name*

Technical School Address*

Street Address Address Line 2 City State ZIP Code

Additional Technical School Activities

College Information

College Years Completed?*

Please enter a value between 1 and 12.

List of Degree(s) Acquired

College Name*

College Address*

Street Address Address Line 2 City State ZIP Code

Additional College Activities

Military Information

Military Status*

I've never served in the U.S. Armed Forces
Veteran of the U.S. Armed Forces
Current Member of the National Guard or Reserves

Branch of Service*

Years of Military Service Completed*

Please enter a value between 1 and 30.

Military Job, Duties, Qualifications and Schools*

Employment Information

Do you have friends or relatives that are currently employed with us?*

Yes
No

Name(s) and Relationship of Workers*

Have you ever applied for employment with us before?*

Yes
No

Date Applied*

Have you ever been employed with us before?*

Yes
No

Start Date Employed*

End Date Employed*

Are you currently employed?*

Yes
No
Laid-Off (and Subject to Recall)

How many previous employers would you like to add to this application?*

1st Most Recent or Current Employer

Employer's Name

Employer's Address

Street Address Address Line 2 City State ZIP Code

Employer's Phone

May we contact this employer?*

Yes
No

Supervisor's Name

Position and Duties

Salary

Hourly Rate (or Equivalent)

Start Date

End Date

Reason For Leaving

(if applicable, else leave blank)

2nd Most Recent Employer

Employer's Name

Employer's Address

Street Address Address Line 2 City State ZIP Code

Employer's Phone

May we contact this employer?*

Yes
No

Supervisor's Name

Position and Duties

Salary

Hourly Rate (or Equivalent)

Start Date

End Date

Reason For Leaving

(if applicable, else leave blank)

3rd Most Recent Employer

Employer's Name

Employer's Address

Street Address Address Line 2 City State ZIP Code

Employer's Phone

May we contact this employer?*

Yes
No

Supervisor's Name

Position and Duties

Salary

Hourly Rate (or Equivalent)

Start Date

End Date

Reason For Leaving

(if applicable, else leave blank)

4th Most Recent Employer

Employer's Name

Employer's Address

Street Address Address Line 2 City State ZIP Code

Employer's Phone

May we contact this employer?*

Yes
No

Supervisor's Name

Position and Duties

Salary

Hourly Rate (or Equivalent)

Start Date

End Date

Reason For Leaving

(if applicable, else leave blank)

5th Most Recent Employer

Employer's Name

Employer's Address

Street Address Address Line 2 City State ZIP Code

Employer's Phone

May we contact this employer?*

Yes
No

Supervisor's Name

Position and Duties

Salary

Hourly Rate (or Equivalent)

Start Date

End Date

5th Reason For Leaving

(if applicable, else leave blank)

List Additional Skills

Include any pertinent activities, apprenticeships, certifications, training or schooling

References

How many personal references would you like to add to this application?*

1
2
3

1st Reference Name and Phone Number

1st Reference Years Known

Please enter a value between 1 and 65.

2nd Reference Name and Phone Number

2nd Reference Years Known

Please enter a value between 1 and 65.

3rd Reference Name and Phone Number

3rd Reference Years Known

Please enter a value between 1 and 65.

Are there specific days or times to best contact you?*

Yes
No

Best Days to Contact You

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

From:

: HH

MM

To:

: HH

MM

How did you learn about us?*

Upload Files

Uploads can include: Cover Letter, Resume, Completed PDF Application, Employment Eligibility Documents, Education Diplomas, Military Documents (DD-214) and any other Certifications (10 files / 64mb total)

Drop files here or

Signature*

Sign using your mouse (or finger on a mobile device)

“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 THT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION. I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE.”

Security Check

Name

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