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Enprotec/Hibbs & Todd, Inc.
402 Cedar Street
Abilene, Texas 79601

Enprotec/Hibbs & Todd, Inc. is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.

Personal:

Application Date:*

Name:*

First Middle Last

Address:*

Number & Street City State ZIP Code

Phone Number:*

Email Address*

Position Sought:*

Full or Part Time?*

Full Time
Part Time

Are you over 18 years old?*

Yes
No

Are you legally eligible for employment in the United States?*

Yes
No

(if offered you will be required to provide documentation to verify eligibility)

Do you have a valid Texas Driver's license?*

Yes
No

Have you previously been employed by Enprotec/Hibbs & Todd Inc.?*

Yes
No

When?*

(MM/YYYY through MM/YYYY)

Where:*

Do you have friends or relatives currently employed at Enprotec/Hibbs & Todd, Inc.?*

Yes
No

Who?*

During the last ten years, have you ever been convicted of a crime other than a minor traffic offense?*

Yes
No

(A conviction will not necessarily automatically disqualify you for employment. Rather such factors as age and date of conviction, seriousness, and nature of the crime, and rehabilitation will be considered)

Explain:*

Have you ever been discharged or asked to resign from a job?*

Yes
No

Explain:*

May we contact your present employer?*

Yes
No

Education:

Please indicate education or training which you believe qualifies you for the position you are seeking.

High School:

Number of years completed

Diploma

Yes
No

GED

Yes
No

High School Name:

Address

City State

College and/or Vocation School:

Number of years completed

Other:

College Name:

Address

City State

Major*

Degree(s) earned*

College Name:

Address

City State

Major

Degree(s) earned

Other Training or Degrees:

School:

Address

City State

Course

Degree or Certificate(s) earned

Professional License(s) or Memberships:

License/Membership 1:

Type of license or membership held

Issuing state:

License/Membership 2:

Type of license or membership held

Issuing state:

License/Membership 3:

Type of license or membership held

Issuing state:

(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status, or any other protected status)

OFFICE PROFICIENCIES: Are you proficient in:

Microsoft Office*

Yes
No

Microsoft Excel*

Yes
No

Microsoft PowerPoint*

Yes
No

Quickbooks*

Yes
No

Corel WordPerfect*

Yes
No

Corel QuatroPro*

Yes
No

Autocad*

Yes
No

Typing*

Yes
No

List any other computer software programs that you are proficient in:

Employment History:

List current (or last) employer first, including U.S. Military Service.

If any employment was under a different name, indicate name:

Employer 1:

Employer Name:*

Address*

Address Line 1 City State ZIP Code

Telephone number*

Dates of employement*

(From Month/Year to Month/Year)

Position*

Salary*

Supervisor*

Reason for leaving*

Employer 2:

Employer Name:

Address

Address Line 1 City State ZIP Code

Telephone number

Dates of employement

(From Month/Year to Month/Year)

Position

Salary

Supervisor

Reason for leaving

Employer 3:

Employer Name:

Address

Address Line 1 City State ZIP Code

Telephone number

Dates of employement

(From Month/Year to Month/Year)

Position

Salary

Supervisor

Reason for leaving

Employer 4:

Employer Name:

Address

Address Line 1 City State ZIP Code

Telephone number

Dates of employement

(From Month/Year to Month/Year)

Position

Salary

Supervisor

Reason for leaving

Employer 5:

Employer Name:

Address

Address Line 1 City State ZIP Code

Telephone number

Dates of employement

(From Month/Year to Month/Year)

Position

Salary

Supervisor

Reason for leaving

If you wish to describe additional work experience, complete the above information for each position below.

Explain any gaps in work history:

PROFESSIONAL REFERENCES:

Name:

First Last

Address

Address Line 1 City State ZIP Code

Phone

Name:

First Last

Address

Address Line 1 City State ZIP Code

Phone

PERSONAL REFERENCES:

Name:

First Last

Address

Address Line 1 City State ZIP Code

Phone

Name:

First Last

Address

Address Line 1 City State ZIP Code

Phone

THIS APPLICATION FOR EMPLOYMENT IS GOOD FOR 30 DAYS ONLY. CONSIDERATION FOR EMPLOYMENT AFTER 30 DAYS REQUIRE A NEW APPLICATION.

Applicant's Certification and Agreement

I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Enprotec/Hibbs & Todd, Inc. to verify their accuracy and to obtain reference information about my work performance. I hereby release Enprotec/Hibbs & Todd, Inc. from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information.

I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal.

I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulation of employment of Enprotec/Hibbs & Todd, Inc. However I, further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or Emprotec/Hibbs & Todd, Inc. may terminate my employment at any time with or without notice or cause.

Signature of applicant*

Date*

Please read and sign the AUTHORIZATION FOR CONSUMER REPORTS in the next section.

Authorization Form for Consumer Reports

In connection with my application for employment at Enprotec/Hibbs and Todd, Inc., I understand that consumer reports or investigative consumer reports which may contain public record information may be requested or made on me including consumer credit, criminal records, driving records, education and prior employer verification.

By signing below, I hereby authorize without reservation, any party or agency contacted to furnish the abovementioned information. I further authorize ongoing procurement of the abovementioned reports at any time during my employment.

I hereby authorize and request, without any reservation, any present or former employer, school, police department, financial institutions, division of motor vehicles, consumer reporting agencies, or other persons or agencies having knowledge about me to furnish any and all background information in their possession regarding me.

By signing my name below, I

indicate that I have carefully read and understand this Authorization form.

Consent to the release of consumer reports to the company in conjunction with this application.

Understand that if the Company hires me, my consent will apply throughout my employment unless I revoke or cancel my consent in writing by sending a signed letter or statement to the Company.

Authorize the disclosure of information concerning my employment history, earning history, education, criminal history, and motor vehicle history.

Confirm that I have received a copy of "A Summary of Your Rights Under the Fair Credit Reporting Act".

The Authorization form in original, faxed, photocopied or electronic form, will be valid for any reports that may be requested by the Company.

Signature:*

Printed Name:*

First Last

Date:*

Driver's License State:

Email

This field is for validation purposes and should be left unchanged.

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Application Form

Personal:

Education:

Employment History:

Applicant's Certification and Agreement

Authorization Form for Consumer Reports