Application

Application for Employment we are an equal opportunity employer We consider all applicants for all positions without regard to race, color, religion, sex, natural origin, age, veteran status, disability (which can be reasonably accommodated), or any other legally protected status. Please fill out all information fully
Date of Application ie 01/01/2007
Position Applied For Welding (requires previous welding experience and mechanical background) Electrician (licensed or non-licensed) Paint Department (sandblaster, painter)

First Name Middle Name Last Name
Street Address City State Zip Code
Telephone Cell Phone email address
Are you under the age of 18? Yes No
Are you legally eligible for employment in the United States? Yes No
Have you been convicted of a felony within the last 7 years? Yes No If yes, please explain
How did you learn about Dakota Pump, Inc.? Radio Walk-In Newspaper Friend/Relative Employment Agency
Have you ever been employed with us before? Yes No If yes, please give dates you worked here
Are you capable of satisfactorily performing the essential job duties of the position for which you are applying, with or without reasonable accommodation? Yes No
Do you have a valid drivers license? Yes No Drivers License Number State of Issue Expiration Date Operator Commercial (CDL) Can you travel if a job requires it? Yes No
Education Name of School Type of School High School College/Technical School Address of School Diploma Degree Name of School Type of School High School College/Technical School Address of School Diploma Degree GED
References (Please list two references other than relatives or previous employers) Name Phone Number Address Relationship Name Phone Number Address Relationship
Work Experience (Please list your previous work experience beginning with your most recent job held. Include explanation for any gaps in employment. If you were self-employed, give firm name) Name of Employer Address City State Phone Number Your Last Job Title Last Supervisor Employment Dates : To From Reason For Leaving (be specific) List duties performed, skills used or learned, advancements or promotions while you worked at this company. May we contact your present employer? Yes No
Name of Employer Address City State Phone Number Your Last Job Title Last Supervisor Employment Dates : To From Reason For Leaving (be specific) List duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of Employer Address City State Phone Number Your Last Job Title Last Supervisor Employment Dates : To From Reason For Leaving (be specific) List duties performed, skills used or learned, advancements or promotions while you worked at this company.
Application for Employment Questionnaire Please Check The Appropriate Skill Level and Answer the Questions to the Best of Your Knowledge
Welding Cutting Torch (oxy/acy) None Some Skilled Heating Torch None Some Skilled Air Arc Gouge None Some Skilled Plasma Cutter None Some Skilled Stick Welding None Some Skilled Flux Core Welding None Some Skilled Wire Feed Welding None Some Skilled Aluminum Welding None Some Skilled Hand Tools Sockets & Wrenches None Some Skilled Air/Electric Impacts None Some Skilled Torque Wrench None Some Skilled Step Jacks None Some Skilled Hydraulic Jacks None Some Skilled Chain Hoists None Some Skilled Porta Powers None Some Skilled Grinders None Some Skilled Chop Saws None Some Skilled Drills None Some Skilled Heavy Equipment Operation Forklift (all-terrain) None Some Skilled Overhead Cranes None Some Skilled Painting Masking None Some Skilled Airless Paint Sprayer None Some Skilled What Type/Brand Orbital Sanders None Some Skilled Sand Blaster None Some Skilled What type of blasting equipment have you used? General Knowledge Please add the following: 1-1/8 + 1-1/2 = Please add the following 1-15/16 + 1-3/8 = When heat is applied to steel it contracts expands When using a number 2 cutting tip on a standard oxy/propane cutting torch, set your oxy around and your propane around Wire feed welding: What corrections need to be made when your welds have porosity (pin holes)? Blueprint Reading None Some Skilled Computer Knowledge None Some Skilled Programs Used Can you work at heights of 14 feet or more? Yes No Are you claustrophobic or uncomfortable working in confined spaces? Yes No
Applicant's Statement PLEASE READ THE FOLLOWING I certify that answers given in this application are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application or in any interview is sufficient cause for refusal to hire, or dismissal if I have been employed. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at any employment decision. This application for employment shall be considered active for 90 days. Any applicant not hired during this time period must complete a new application to be considered for employment. I understand that my employment is contingent upon passing a post-offer pre-employment screen for illegal drug usage. I further understand that if I am hired, my employment will be "At-Will" and without fixed term, and may be terminated at any time, with or without prior notice, at the option of either myself or the Company. I understand the contents of this applicant's statement and hereby acknowledge receipt of this information. I agree that by checking this box that all of the answers and statements are true and correct within my application and that it serves as my electronic signature. Type your full name I agree Thank You for your interest in Dakota Pump , Inc. Please only click the submit button one time to submit your online application to DAKOTA PUMP , INC.