APPLY NOW CONTACT INFORMATION Name* First Last Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Email* Phone* LEGAL INFORMATION Are you at least 18 years of age?* Yes No If hired, can you prove evidence of legal eligibility to work in the U.S.?* Yes No Have you ever been convicted of a criminal offense which has not been annulled or sealed by a court?* Yes No Have you ever been discharged or asked to resign by an employer?* Yes No POSITIONS Please select up to 2 positions that you wish to be considered for from the list.* Auto/Heavy Equipment Mechanic Clerk Craft Apprentice/Helper Laborer FG-CSA Planner/Scheduler Project Manager Safety Coordinator QA/QC Inspector Assistant Superintendent Superintendent Craft Foreman General Foreman CDL Truck Driver ASME Certified Welder (Alloy) ASME Certified Welder (Carbon Steel) Heavy Equipment Operator NCCCO-NCCER Crane Operator NCCER Certified Boilermaker NCCER Certified Carpenter NCCER Certified Electrician NCCER Certified Ironworker NCCER Certified Millwright NCCER Certified Pipefitter Concrete Finisher Wage Desired: Date you can begin work?: Would you be available for overtime?* Yes No Would you be available for full or part-time?* Full-Time Part-Time PAST ADDRESSES Please list any past THREE (3) addresses that you have resided. From: MM/YYYY To: MM/YYYY Address City State / Province / Region ZIP / Postal Code From: MM/YYYY To: MM/YYYY Address City State / Province / Region ZIP / Postal Code From: MM/YYYY To: MM/YYYY Address City State / Province / Region ZIP / Postal Code EMERGENCY CONTACT Please list your emergency contact. Name Relationship Phone EDUCATION Please list any trade schools you have attended or courses you have taken that may be job-related or that you feel would be of value to this job or company. HIGH SCHOOL School Name* Year(s)* City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State Did you graduate:* Yes No CURRENT SCHOOL INFORMATION Are you presently enrolled in school? Yes No If yes, what is the name of the school? Address City State / Province / Region Expected Degree Date COLLEGE School Name Address City State / Province / Region Major Did you graduate? Yes No CERTIFICATIONS Do you possess a current Transportation Workers Identification Credential (TWIC) Card? Yes No Do you possess a current ISTC Badge? Yes No Please list current classes below: Do you possess a NCCER or Other Craft Certification(s) Yes No Please list certifications below: Please list any job-related skills or accomplishments, including military service: EMPLOYMENT INFORMATION Please list positions (up to 3) that you have held that are pertinent to the position for which you are applying. EMPLOYER 1 Name of Employer Address Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Supervisor Phone Job Title and Duties End Date of Employment Starting Pay Ending Pay Reason for Leaving EMPLOYER 2 Name of Employer Address Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Supervisor Phone Job Title and Duties End Date of Employment Starting Pay Ending Pay Reason for Leaving EMPLOYER 3 Name of Employer Address Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Supervisor Phone Job Title and Duties End Date of Employment Starting Pay Ending Pay Reason for Leaving AUTHORIZATION For the release of personal data and record information As a condition of my employment with the Company, I understand that I must undergo and pass, to the Company’s satisfaction, a thorough investigation on educational background, employment experience, personal references, criminal/civil records, motor vehicle, record check, credit check, and physical examination, including a drug screen. I hereby authorize and request that any of the above information be provided to the Company. I further agree to release from all liabilities all persons and companies requesting or supplying information with respect to this inquiry. A photocopy of this authorization may be treated with the same authority as an original. Typing your name into the following textbox constitutes a signature for all purposes described above. Please enter your name in the following textbox:* Sign ACKNOWLEDGEMENTS Please read and acknowledge each of the following by placing your initials in the textbox below each statement: 1.) I certify that all statements I have made in this application are true and agree that any misrepresentation or omission of facts requested may be sufficient cause for cancelation of my application or immediate dismissal from the Company, if I have been employed. In the event I am employed, I agree to conform to the rules and policies of the Company. I understand that these rules and policies may be changed, interpreted, withdrawn, or added to at the Company’s option at any time without notice. Initial* 2.) If I accept a job offer from the Company, I consent and agree to take a physical examination, if required, prior to beginning work. I agree to take such future physical examinations that may be required by the Company. I agree to submit to any lawful drug and alcohol testing, or skills and qualification testing that may be required either as a condition for employment or for continued employment. I understand and agree that refusal to submit to such testing during the course of my employment will result in immediate termination. Initial* 3.) I acknowledge the Company’s notification to me that a background investigation and/or an investigative consumer report on me may be made. I understand and agree that successful completion to the Company’s satisfaction of such investigation is required for employment or continued employment. I hereby authorize the Company to conduct or have conducted the investigation described above. Initial* 4.) I understand and agree that if any employment relationship is established with the Company, it will be of an “at will” nature. I understand that “at will” means that I may resign at any time and the Company may dismiss me at any time, with or without cause. I understand and agree that this “at will” employment relationship cannot be changed by any written document or oral statement unless this change is specifically acknowledged in writing by the President or higher level officer of the Company. Initial* 5.) I agree that the Company’s liability to me for wages is limited to the amount earned by me as of the date of such termination. I also authorize the Company to deduct at any time any funds owed by me to the Company whenever such deduction is not prohibited by law. Initial* 6.) I understand that federal law prohibits the employment of unauthorized aliens and that all persons hired must submit satisfactory proof of employment authorization and identity. I further understand that the failure to submit such proof will result in my immediate dismissal from the Company if I have been employed. Initial* 7.) I understand that my disclosure of prior convictions for criminal offenses will not necessarily prevent my employment with the Company; however, the omission of this requested information will be sufficient cause for cancellation of my application or my immediate dismissal from the Company. Initial* 8.) I have received a written job description and had the requirements of the job explained to me. I understand these requirements and represent to the Company that I can perform these requirements with or without reasonable accommodation. Initial* 9.) I have read and agree to the above acknowledgements. Initial* SIGNATURE Please indicate that all of the above is true by entering your full legal name in the following textbox: Signature* Signature Before submitting your application, please check the box below as an anti-spam precaution.* CAPTCHA HOW TO FIND US TRIPLE “S” INDUSTRIAL CORPORATION Main Office 860 W Chance Rd Lumberton, TX 77657 Mailing Address PO BOX 8069, Lumberton TX 77657 TEL: (409) 755 4077 FAX: (409) 755 4133 EMAIL: INFO@TRIPLESINDUSTRIAL.COM Follow Us © 2021 All Rights Reserved