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    We Are An Equal Opportunity Employer.

    PERSONAL INFORMATION

    Incomplete information could disqualify you from further consideration.

    Today's date:

    Are you eligible to work in the U.S?

    YesNo

    Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)

    YesNo

    Have you ever been terminated from employment or asked to resign by an employer?

    YesNo

    Can you work any shift?

    YesNo

    Can you work overtime, including weekends?

    YesNo

    Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation

    YesNo

    EMPLOYMENT DESIRED

    Date you can start

    Location

    Are you currently employed?

    YesNo

    REFERRAL SOURCE

    How did you hear about us?

    Walk InAdvertisementReferralOther

    Have you ever worked for this company before?

    YesNo

    Do you know anyone who works for our company?

    YesNo

    EDUCATION

    High School

    College or University

    Trade, Business or Correspondence School

    EMPLOYMENT HISTORY

    Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

    From

    To

    From

    To

    From

    To

    From

    To

    REFERENCES

    Give the full-names of three persons not related to you, whom you have known at least three (3) years.

    1

    2

    3

    Upload Resume .PDF (optional)

    Please read carefully before signing.*

    Brotherton Pipeline is an equal opportunity employer. Brotherton Pipeline does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.
    I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for [Company Name] to hire me. If I am hired, I understand that either Brotherton Pipeline or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Brotherton Pipeline has the authority to make any assurance to the contrary.
    I attest with my signature below that I have given to Brotherton Pipeline true and complete information on this application. No requested information has been concealed. I authorize to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

    Electronic Signature*

    I understand that checking the box below constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

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    Date

    THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE SIGNED/DATED ABOVE.