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VERNOR MATERIAL & EQUIPMENT CO., INC.
545 Wilson Rd
FREEPORT, TX 77541
APPLICATION FOR EMPLOYMENT

Today's Date *

Name *

First

Last

Telephone Number : *

Birth Date: *

Driver License #: *

Driver Licence Class:

Driver Licence Expiration date: *

Permanent Address- Street & Number : *

City: *

State: *

Zip: *

Country: *

Are you 18 years or older? *

Yes
No

Are you a U.S. Citizen? *

Yes
No

If Non-Citizen, indicate type of Visa:

Resident
Visitor
Student
Other

Have You Ever Been Employed by Vernor Material?

Yes
No

List Below Any Relatives Employed by Us:

Have You Used Any Recreational Drugs in The Past 60 Days? *

Yes
No

Have You Worked for DOW Within the Last 90 Days?

Yes
No

If YES, Please Select Reason for Leaving:

Resigned
Terminated
Reduction of Force
None

Email *

Are You Currently Employed? *

Yes
No

If NO, How Long Since Last Employment? (Years and Months)

Position Applying for:

Years of Experience: (Years and Months)

Second Choice:

Years of Experience: (Years and Months)

REFERENCE #1 Name: (NON-RELATIVE References) *

REFERENCE #1 Phone Number: *

REFERENCE #1 Time Known:

REFERENCE #2 Name: (NON-RELATIVE References)

REFERENCE #2 Phone Number:

REFERENCE #2 Time Known:

REFERENCE #3 Name: (NON-RELATIVE References)

REFERENCE #3 Phone Number:

REFERENCE #3 Time Known:

Employment History 1 : Company Name

Employment History 1 : Company Telephone Number

Employment History 1 : Company Address

Employment History 1 : Type of Business

Employment History 1 : Starting Salary $

Employment History 1 : Ending Salary $

Employment History 1 : From Date

Employment History 1 : To Date

Employment History 1 : Reason for Leaving:

Employment History 1 : May We Contact Previous/Current Supervisor for a Reference?

Yes
No

Employment History 1 : Job Duties and Responsibilities:

Employment History 2 : Company Name

Employment History 2 : Company Telephone Number

Employment History 2 : Company Address

Employment History 2 : Type of Business

Employment History 2 : Supervisor’s Name

Employment History 2 : Reason for Leaving

Employment History 2 : Job Title

Employment History 2 : Starting Salary $

Employment History 2 : Ending Salary $

Employment History 2 : From Date

Employment History 2 : To Date

Employment History 2 : Reason for Leaving:

Employment History 2 : May We Contact Previous/Current Supervisor for a Reference?

Yes
No

Employment History 2 : Job Duties and Responsibilities:

DRIVERS SECTION ONLY 1 - State

DRIVERS SECTION ONLY 1 - License Number

DRIVERS SECTION ONLY 1 - Class

DRIVERS SECTION ONLY 1 - Expiration Date

DRIVERS SECTION ONLY 2 - State

DRIVERS SECTION ONLY 2 - License Number

DRIVERS SECTION ONLY 2 - Class

DRIVERS SECTION ONLY 2 - Expiration Date

LIST ALL YOUR TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST THREE YEARS 1: Location

LIST ALL YOUR TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST THREE YEARS 1 : Date

LIST ALL YOUR TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST THREE YEARS 1 : Charge

LIST ALL YOUR TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST THREE YEARS 1: Penalty

LIST ALL YOUR TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST THREE YEARS 2 : Location

LIST ALL YOUR TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST THREE YEARS 2 : Date

LIST ALL YOUR TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST THREE YEARS 2 : Penalty

LIST ALL YOUR TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST THREE YEARS 2 : Charge

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