BENCHMARK INDUSTRIAL SERVICES, INC.
P.O. Box 931
Kilgore, Texas 75663
APPLICATION FOR EMPLOYMENT
Personal Information
Name
SS#
Date
Mailing address
City
State
Zip
phone #
mobile #
Are you 18 years or older?
Yes
No
Are you prevented from lawfully becoming employed in this Country because of visa or immigration status?
Yes
No
in case of emergency notify
phone #
relationship
Employment Desired
position
date available desired
salary desired
Are you employed now?
Yes
No
if yes, may we inquire of your present employer?
Yes
No
Have you applied with this company before?
Yes
No
WHEN?
Referred by
Education
Grammar School
Location of school
Years
Did You Graduate?
Yes
No
Subjects Studied
High School
LOCATION OF SCHOOL
YEARS
DID YOU GRADUATE?
Yes
No
SUBJECTS STUDIED
College or Trade School
LOCATION OF SCHOOL
YEARS
DID YOU GRADUATE?
Yes
No
SUBJECTS STUDIED
Type of Equipment you can Operate
Equipment Size
Experience Length - Month / Years
TYPE OF EQUIPMENT YOU CAN OPERATE
EQUIPMENT SIZE
EXPERIENCE LENGTH - MONTH / YEARS
TYPE OF EQUIPMENT YOU CAN OPERATE
EQUIPMENT SIZE
EXPERIENCE LENGTH - MONTH / YEARS
TYPE OF EQUIPMENT YOU CAN OPERATE
EQUIPMENT SIZE
EXPERIENCE LENGTH - MONTH / YEARS
TYPE OF EQUIPMENT YOU CAN OPERATE
EQUIPMENT SIZE
EXPERIENCE LENGTH - MONTH / YEARS
U.S. military or naval service
present membership in national guard or reserves?
rank
Former Employers (List below the last three employers -- most recent one first)
Company Name
ADDRESS
Phone #
Position Held and Responsibilities
beginning salary
ending salary
Employed From (date)
Employed To (date)
reason for leaving
COMPANY NAME (#2)
address
phone #
POSITION HELD AND RESPONSIBILITIES
BEGINNING SALARY
ENDING SALARY
employed from (date)
employed to (date)
REASON FOR LEAVING
COMPANY NAME (#3)
address
phone #
POSITION HELD AND RESPONSIBILITIES
BEGINNING SALARY
ENDING SALARY
employed from (date)
employed to (date)
REASON FOR LEAVING
References
Name
address
business
Phone #
Yrs Acquainted
NAME
ADDRESS
business
Phone #
YRS ACQUAINTED
NAME
ADDRESS
business
Phone #
YRS ACQUAINTED
Please take the time to review the equipment listed below and mark your experience in months or years. In addition, list any other equipment experience that you may have that is not listed.
Work History
blade operator experience
model
bobcat loader EXPERIENCE
model
coal drill operator EXPERIENCE
model
coal truck driver EXPERIENCE
model
Crane Operator experience
model
Dozer Operator experience
model
Dragline Assistant
Model
Dragline Groundperson experience
model
Dragline Operator experience
model
dump truck experience
model
electrician experience
model
farm tractor experience
model
Front-End Loader Operator experience
model
Loading Shovel Operator experience
model
mechanic experience
model
over the road truck experience
model
Overburden Truck Driver experience
model
Service Person experience
model
Shooter & Blaster experience
model
trackhoe experience
model
utility experience
model
water pumper experience
model
welder experience
model
other experience
model
Please indicate below any relatives currently or previously employed with Benchmark Industrial Services, Inc. or Sabine Mine.
Previously Employed Relatives
name of relative
relationship
name of relative
RELATIONSHIP
name of relative
RELATIONSHIP
name of relative
RELATIONSHIP
name of relative
RELATIONSHIP
name of relative
RELATIONSHIP
name of relative
RELATIONSHIP
name of relative
RELATIONSHIP
name of relative
RELATIONSHIP
* Note: Please indicate relatives that are...
Employee's
Spouse
Child
Mother
Father
Brother
Sister
Grandfather
Grandmother
Grandchild
Foster Child
Niece
Nephew
Spouse's
Mother
Father
Brother
Sister
Grandfather
Grandmother
Niece
Nephew