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EMPLOYMENT APPLICATION

EQUAL OPPORTUNITY EMPLOYER

GSI Engineering is an equal opportunity employer. We do not unlawfully discriminate in employment.  No question on this application is used for the purpose of limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law.  Equal access to employment, services, and programs is available to all persons. Applicants who require reasonable accommodation to the application and / or interview process should notify a representative of GSI.

INSTRUCTIONS:

Fully complete this application

If a question does not apply to you, type "N/A" in the box

Please read and click the Acknowledgements at the bottom of the application

Position applying for:

First Name & Mid Init:

Last Name:

Email Address:

Current Address:

Current City & State:

Zip Code and Phone:

Date You Can Start:

Desired Salary:

Best Time To Conact You:

Ever Applied to GSI?

If yes, provide date:

Previous Employee?

Provide Job Title & Dates:

Can you, after employment, submit verification of legal employment authorization and identity?

If you are under 18 years of age, can you provide required proof of your eligibility to work?.......

Can you travel if required for the position you are applying for? ..................................................

Are you currently employed?..........................................................................................................

May we contact your present employer?........................................................................................

Are you available to work?

Have you ever been convicted of a crime?

If yes, please explain. NOTE: Criminal convictions are not an absolute bar to employment but will be considered only in relation to specific job requirements.

You may be asked to drive on company business. Do you have a valid driver's license? ..............

In the last five (5) years have you been convicted of (or forfeited bond or collateral for) any violation of the motor vehicle laws or ordinances (except parking tickets) of any city or state? ....................................................

If yes, you must identify the nature, date, and any facts or circumstances of each traffic conviction and any facts that you feel might be relevant to such traffic convictions.

For job positions that may involve field and/or lab work, you must be able to safely perform the following functions:

Ability to lift 75 lbs.

Follow established test procedures

Sample retrieval and soil handling

Assist in well installation and completion

Wear a respirator on environmental jobs

Conduct sampling and casting of fresh concrete

Conduct compaction testing

Have good communication and writing skills

Other related job duties as required or assigned

Are you able to perform all the functions of the job position for which you are applying?.................

If no, please indicate reason.

EDUCATIONAL BACKGROUND

List school name, location, years completed, field of study or area of concentration, and any diploma or degrees earned:

School

Location

Yrs Comp

Field of Study or Area of Concentration

Diploma / Degree Earned

High School:

College:

Tech / Trade School:

Other:

EMPLOYMENT EXPERIENCE / WORK RECORD

In order to verify that you meet the qualifications, this section must be filled out completely even if a resume is attached.  This information is required for application processing.  If this information is not complete, the application will be returned to you.

List the positions that you have held, starting with your current or most recent.  If you held more than one position with the same organization, or if you were in the military and had multiple assignments, list each separately.

Employer:

Address:

Supervisor's Name:

City:

State:

Zip:

Phone:

Dates of Employment:

To:

From:

Position Held:

Reason for leaving:

Duties:

Employer:

Address:

Supervisor's Name:

City:

State:

Zip:

Phone :

Dates of Employment:

To:

From:

Position Held:

Reason for leaving:

Duties:

Employer:

Address:

Supervisor's Name:

City:

State:

Zip:

Phone:

Dates of Employment:

To:

From:

Position Held:

Reason for leaving::

Duties:

Employer:

Address:

Supervisor's Name:

City:

State:

Zip:

Phone:

Dates of Employment:

To:

From:

Position Held:

Reason for leaving:

Duties:

REFERENCES

List names and phone numbers for three individuals in supervisory or co-worker capacity who can attest to your abilities.

Paste your cover letter and resume in the fields below:

COVER LETTER:

RESUME:

Please read and agree to the following:

ACKNOWLEDGEMENTS:

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 cancellation of my application or immediate dismissal from GSI, if I have been employed.  In the event I am employed, I agree to conform to the rules and policies of GSI.  I understand that these rules and policies may be changed, interpreted, withdrawn, or added to at GSI's option at any time without notice.

I understand that employment is contingent upon meeting the physical requirements of the job and passing, to GSI's satisfaction, a drug screen.  A post-hire physical examination may also be required if applicable to the offered job description.  All pre-employment/post-hire drug and medical tests are at the expense of GSI

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 within three days of being hired.  I further understand that failure to submit such proof within the required time will result in my immediate dismissal

I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or GSI's option.  I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by GSI.  I understand that no GSI representative, other than its President, and then only in writing, and signed by the President, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

I acknowledge GSI's notification to me that a background investigation which includes, among other things: motor vehicle records; federal, state and county criminal history records; previous employers; professional licensing authorities; and educational institutions.  I understand that my disclosure of prior convictions for criminal or traffic offenses will not necessarily prevent my employment with GSI; however, the omission of this requested information will be sufficient cause for cancellation of my application or my immediate dismissal from GSI.  I understand and agree that successful completion to GSI's satisfaction of such investigation(s) is required for employment or continued employment.  I hereby authorize GSI to conduct or have conducted the investigation(s) described above and to prepare to cause to be prepared a report based on such information.  I further understand that, upon my written request, a complete disclosure of the nature and scope of the investigation(s) conducted will be provided to me.

Maiden names or other names formerly used: 

Date last used:

Date of birth:

Drivers License No:

State issued in:

Previous address:

City:

State:

Zip code:

County:

From date:

To date:

Previous address:

City:

State:

Zip code:

County:

From date:

To date:

I have read and agree to the above acknowledgements.

SEND CLEAR