INBERG-MILLER ENGINEERS
124 East Main Street
Riverton, WY 82501
307-856-8136

EMPLOYMENT APPLICATION

INBERG-MILLER ENGINEERS is an at-will employer and retains the absolute
right to terminate any employee, at any time, with or without good cause.

APPLICANT INSTRUCTIONS

If you need help filling out this application form, please send email to wsteeds@inberg-miller.com and we will be glad to answer your questions.

1. Please read "APPLICANT NOTE" below.
2. If more space is needed to complete any question, use the comments section. Feel free to e-mail, fax or mail any supplementary information such as a resume, letter of recommendation, etc. We will also require a transcript from the college(s) you have attended. Respond to:

Inberg-Miller Engineers
Attn: Wendi Steeds
124 East Main Street
Riverton, WY 82501 		      phone: 307-856-8136
fax: 307-856-3851
e-mail: wsteeds@inberg-miller.com

3. PLEASE NOTE "NOT APPLICABLE" IF NOT ANSWERING A QUESTION.

4. To move through the fields please press TAB. Due to the length of this application it is neccessary that you DO NOT hit the RETURN BUTTON until you have totally completed the application as it will send an incomplete application.

Today is:

LAST NAME:
FIRST NAME:    M.I.:
HOME PHONE:    WORK PHONE:
EMAIL:
CURRENT ADDRESS:
Street:
City:
State:     Zip:
PRIOR ADDRESS:
Street:
City:
State:    Zip:

 

APPLICANT NOTE:
This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

AVAILABILITY
For which position are you applying?
What date can you start?
What category would you prefer? Full-time    Part-time    Temporary    Pool

For which schedules are you available?* 

* Reasonable efforts will be made to accommodate religious beliefs and practices.

 Weekdays    Weekends    Nights
Overtime    Holiday     Other:


JOB-RELATED SKILLS

(NOTE: Do not fill out any part of this section you believe to be non-job related.)
Yes    No If the job requires, do you have the appropriate valid drivers license?
Name on license:   
DL#:
Type:   State of issue:
Yes    No Have you had any moving violations?
Please describe:
Please list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or company:
Yes    No Have you been given a job description or had the essential functions of the job explained to you?
Yes    No Do you understand these essential functions?
Yes    No Can you perform the essential functions of this job with or without reasonable accommodation?
  List languages in which you are fluent:

 

SECURITY
List states and counties of residence for the past seven years:
Yes    No Have you used any names other than given above? If so, please list in comments below.
Yes    No Have you been convicted of a crime in the past seven years? If so, please describe in the boxes below. (Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.)
 
1.
2.
INCIDENT:
CITY:
STATE:
CHARGE:


Comments (Maximum 138 characters.):
    characters left

 

PREVIOUS EMPLOYERS

PLEASE NOTE: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Obtain a phone book or call information if necessary. FOR EMPLOYERS OUTSIDE THE U.S., A CURRENT FAX NUMBER IS MANDATORY.
MOST RECENT EMPLOYER
Yes    No Are you currently working for this employer?
Yes    No If yes, may we contact:   
Phone:   Fax:
Company Name:
City:   State:
Dates employed:   From   To
Job Title:   Supervisor Name:
Duties (Maximum 138 characters.):
    characters left
Salary: per    Reason for leaving:

 

SECOND MOST RECENT EMPLOYER
Company Name:   
City:   State:
Phone:   Fax:
Dates employed:   From   To
Job Title:   Supervisor Name:
Duties (Maximum 138 characters.):
    characters left
Salary: per    Reason for leaving:

 

THIRD MOST RECENT EMPLOYER
Company Name:   
City:   State:
Phone:   Fax:
Dates employed:   From   To
Job Title:   Supervisor Name:
Duties (Maximum 138 characters.):
    characters left
Salary: per    Reason for leaving:

 

REFERENCES

(Include only individuals familiar with your work ability. Do not include relatives.)
  1. 2.
NAME
ADDRESS
PHONE
YEARS KNOWN
RELATIONSHIP

 

EDUCATION

(NOTE: Do not fill out any part of this section you believe to be non-job related.
Please choose highest grade completed:
If your school records are under a different name than listed at the beginning of the form,
please enter that name:
  High School College Other
Name
City
State
Graduate? Yes Yes Yes
Degree? Yes Yes Yes

 

CERTIFICATION AND RELEASE

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejections of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
   Date: