Name (First, Middle, Last):

Phone Number:    E-Mail:

Are you currently available for work?  Yes  No

What position are you applying for?

Why do you want to join Bonland?

Present address:

     Street (include apt. no., if any)

     City   

     State 

     Zip    

Period of residence?

Previous address, if less than 12 months:

     Street (include apt. no., if any)

     City   

     State 

     Zip    

 Period of residence?

Previous Experience:  (Please select if you have experience in the following areas).

Welding.  What types?  Number of years? 

Rigging.  Number of years? 

Drafting - Manual.    Number of years? 

Drafting - CAD.    Number of years? 

Foreman.    Number of years? 

Work Experience:

1. Company Name: 

Length of Employment:  From To

2. Company Name: 

Length of Employment:  From To

3. Company Name: 

Length of Employment:  From To

4. Company Name: 

Length of Employment:  From To

EDUCATION

College Courses:    Graduated:  Yes  No

Areas of Specialization: 

Trade School:  Graduated:  Yes  No

Areas of Specialization: 

Is there any other information you would like to tell us about yourself?

AFFIDAVIT (Please read carefully)

I authorize without liability investigation of all statements in this application.  I authorize all schools which I attend and all previous employers to furnish to the Company my record, reason for leaving and all information they may have concerning me and I hereby release them and the Company from all liability for any damage whatsoever arising therefrom.

I authorize my neighbors, friends or others with whom I am acquainted or who are acquainted with me to furnish the Company with information used in connection with the evaluation of my qualifications as a prospective employee.  I also authorize the making of a credit bureau investigation report whereby information may be obtained concerning my character , general reputation, personal characteristics and mode of living, whichever may be applicable.  I understand I will be notified if such an investigative report is obtained and I will have the right to make a written request within a reasonable period of time for a complete and accurate discloser of information concerning the nature and scope of the investigation.

I understand that in the event of my employment by the Company, it shall be sufficient cause for dismissal if any of the information I have given in this application is false or if I have failed to give any information herein requested.  In the event of my employment by the Company, I agree to abide by all present and subsequently issued rules of the Company.

I have read and understand the above Affidavit                   Yes    Today's Date: