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?

Willing to work Light Commercial "B" Agreement: Yes  No

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)

It is the policy of Bonland Industries, Inc. to employ personnel on the basis of an individual's qualifications.  Selections are made without regard to race, color, religion, sex, national origin, marital status, sexual orientation, citizenship status, age, handicap or status as a disabled veteran or a veteran of the VietNam era except where age and sex are essential bonafide occupational requirements or where handicap is a bonafide occupational disqualification.

I authorize without liability investigation of all statements in this application.  I authorize all schools which I attended 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 disclosure of information concerning the nature and scope of the investigation.

In processing this application, and during the course of employment, if hired, the Company may request verification of my driving record and insurance coverage.  I authorize the Company to request such information and release them, the Motor Vehicle Division, and the insurance company from any action whatsoever arising therefrom.

I understand that proof of identity and work authorization will be required upon employment in accordance with federal regulations.

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: