Employment Application

Pipeline Services Inc. (Pipeline) is an Equal Opportunity Employer. If you're interested in applying for a job with Pipeline, please complete this online employment application form. Please note that you must click the "Submit" button at the end of the application to forward the form to Pipeline.

First Name

Please enter your first name

Middle Name

Last Name

Please enter your last name

Primary Phone

Please enter a valid phone number.

Alternate Phone

Email Address

Please enter a valid email address.

Social Security Number

Present Address

Please enter an address.

Address 2

City

Please enter a city.

State

Zip Code

Please choose a state.

Permanent Address Address 2

City

State

Zip

If your present address is the same as your permanent address, check here.

Employment Desired

Position Desired

Date You Can Start

Salary Desired

Referred By

Are you employed now?

Please make a selection.

If so, may we inquire of your present employer?

Have you ever applied to Pipeline before?

Please make a selection.

If so, when?

Education History

High School

Name and Location of High School

If so, when?

Did you graduate?

College

Name and Location of College

If so, when?

Did you graduate?

Trade, Business or Other

Name and Location of School

If so, when?

Did you graduate?

General Information

Subject of Special Study/Research Work

Special Training

Special Skills

U.S. Military or Naval Service

Rank

Employment History

List below last four employers, starting with current/most recent first.

Name & Address of Current or Last Employer

Employed from

Employed to

Position

Salary

Reason for Leaving

Name & Address of Employer 2

Employed from

Employed to

Position

Salary

Reason for Leaving

Name & Address of Employer 3

Employed from

Employed to

Position

Salary

Reason for Leaving

Name & Address of Employer 4

Employed from

Employed to

Position

Salary

Reason for Leaving

References

Please provide at least two references.

Name & Address

Business

Years Known

Name & Address

Business

Years Known

Name & Address

Business

Years Known

Authorization

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 they may have, personal or otherwise, and release the company from all liability for any damage that 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.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with a written noticeregarding the use of these reports and will also obtain a separate written authorization from me to consent to these reports. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document from upon hire.

Check here if you agree to the above Authorization.

Electronic Signature

By submitting this Application, you are signing this Application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Application. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and the Company.