HOME CURRENT INDUSTRY NEWS CONTACT US APPLY NOW EMPLOYEE PORTAL ABOUT US SERVICES SCHEDULE AN INSPECTION COVERAGE MAP APPLY NOW Employee Data Sheet Last Name: First Name: Middle Initial: Date: Street Address: City: State: ZIP Code: Telephone No: Email: Date of Birth: Social Security Number: DLD/ID Number: State Issued: Emergency Contacts Full Name: Relationship: Address: Phone: Full Name: Relationship: Address: Phone: Physician Name: Phone: Address: Education Highest Level of Schooling Achieved & Location: Position Information Position Applying For: Date Available to Start: Rate of Pay Expected: Years of CT Experience: Are you legally allowed to work in the United States?YESNO Special Skills, Qualifications or Knowledge- List any special skills, qualifications or knowledge you possess: Answering “yes” to the following question does not bar you from employment with OBR Cooling Towers. Have you plead “guilty” or “no contest” or been convicted of a crime in the past (7) years?YESNO If yes, please explain Can you pass a drug and alcohol test? Urinalysis?YESNO Hair follicle?YESNO Employment History Employer: Dates Employed: To: Supervisor Name & Phone No: Job Title: Hourly Wages: Reason for Leaving? Employer: Dates Employed: To: Supervisor Name & Phone No: Job Title: Hourly Wages: Reason for Leaving? Verification Statement I certify that all of the information in this application is true and correct. I understand that misrepresentation or falsifying information can result in not being considered for employment. My rate of pay and benefits have been explained to me. I understand and agree to these terms Employee Signature: Date: SCHEDULE YOUR INSPECTION CLICK HERE Home About Us Services Schedule an Inspection Coverage Map Current Industry News Contact Us ©2021 OBR Cooling Towers Inc. (419) 243-3443 2845 Crane Way Northwood, OH 43619