Application for Employment

Thanks for seeking employment with our team at Pacific Fluids, LLC.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER—We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

It will take about 30 to 45 minutes to fill out this online Application for Employment. Please allow time to fill it out all in one sitting as the form does not automatically save. If you prefer, you may stop by our office for a printed Application for Employment that you can fill out.

Full Name *

Address (Number, Street, City, State, Zip Code)

Phone Number(s) *

Best time to contact you is?

Email Address *

Position Applying For:

Projected Start Date:

Do you have any friends/relatives who work at Pacific Fluids?

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Are you currently employed?

May we contact your present employer?

Are you a U.S. citizen?

If the answer above is "No," are you able to provide a work visa or immigration status?

What is your desired salary range?

Are you currently on "lay-off" status subject to recall?

Can you travel if a the job position requires it?

EDUCATIONAL BACKGROUND: Name of High School

Location of High School?

High School: Number of Years Attended?

High School Diploma?

EDUCATIONAL BACKGROUND: Name of Undergraduate College?

Location of Undergraduate College?

Undergraduate College: Major?

Undergraduate College: Years Completed

Undergraduate College: Degree Earned?

EDUCATIONAL BACKGROUND: Name of Professional / Graduate School?

Location of Professional / Graduate School?

Professional Graduate School: Course of Study

Professional / Graduate School Degree Earned?

EDUCATIONAL BACKGROUND: Please list any other schools, degrees earned and from where.

Do you have any specialized training / apprenticeship / skills?

Do you have any job-related training received while serving in the United States military?

Most Recent Job: Employer"

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, nation origin, disabilities or other protected status.

Most Recent Job: Address of Employer?

Most Recent Job: Dates Employed (beginning & ending dates)

Most Recent Job: Employer Telephone Number(s)

Most Recent Job Title?

Most Recent Job: Supervisor's Name?

Most Recent Job: Hourly Rate/Salary (starting and final)

Most Recent Job: Work Performed?

Most Recent Job: Reason for Leaving?

Job 2: Employer

Job 2: Address of Employer

Job 2: Employer Telephone Number(s)

Job 2: Job Title

Job 2: Supervisor

Job 2: Dates Employed (from and until)

Job 2: Hourly Rate/Salary (starting and final)

Job 2: Work Performed

Job 2: Reason for Leaving

Job 3. Employer

Job 3. Employer Address

Job 3. Employer Telephone Number(s)

Job 3. Job Title

Job 3. Supervisor

Job 3. Dates Employed (from and until)

Job 3. Hourly Rate/Salary (starting and final)

Job 3. Work Performed

Job 3. Reason for Leaving

If you need additional space for previous employment, please continue in the box below with the same type of information:

List any professional, trade, business or community activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

Additional Qualifications?

Summarize special job-related skills and qualifications acquired from employment or other experience.

Specialized Skills (check skills/equipment operated)

PC/MAC
Microsoft Excel Spreadsheets
Microsoft Word Processing
Forklift Operation
Class A CDL with Hazmat, Tanker, and Doubles Endorsement
Ability to Wear Full-Face Respirator
Math Skills

List Production / Mobile Machinery / Other Specialized Skills relevant to the job position:

Any additional information you feel may be helpful to us in considering your application?

Note to Applicant: DON'T ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING. Are you capable of performing in a reasonable manner, with or without reasonable accommodation, the activities involved in the job for which you have applied? A review of the activities involved in such a job has been given.

Reference 1: Please supply Name, Phone Number, Address & Relationship

Reference 2: Please supply Name, Phone Number, Address & Relationship

Reference 3: Please supply Name, Phone Number, Address & Relationship

I verify that my answers given in this Job Application are true and complete. I authorize Pacific Fluids LLC (PF) the right to investigate all statements contained in this application for employment as may be necessary to help them make an employment decision. This Job Application for employment shall be considered active for up to 60 days. I understand and acknowledge any employment relationship with PF is of an "at will" nature, which means that the Employee may resign at any time and that PF may discharge Employee at any time with or without cause. This "at will" employment relationship can only be changed by an authorized executive of PF. In the event of employment, I understand that false or misleading information given in my application/interview(s) may result in dismissal. In addition, I understand that I am required to follow all rules and regulations of PF.

I confirm all my answers are true and complete

Typing your full name in the box below will be deemed as your digital signature:

Date of Signing: