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Join Us - Assessment Form

* indicates required field

First Name:*

Last Name:*

Date of Birth / Fecha de Nacimiento:

Status:

US Citizen/Ciudadano
Permanent Resident/Residente Permanente
Work Permit/Permiso de Trabajo

Address/Dirección:*

City:*

State:*

Zip Code:*

COUNTY:*

Phone Number:*

Email:*

Gender/Género:*

Female/Femenino
Male/Masculino

What languages do you speak?
Que lenguajes puede usted hablar?

Choose Applicable:

English / Inglés
Spanish / Español
Other / Otro

Can you pass a drug screening?

Please choose one:*

Yes/Si
No/No

Do you have your own transportation to and from work?
Tiene usted su propia transportacion?

Please choose one:*

Yes/Si
No/No

Which zones are you able to travel to work in?
En cuales de las zonas estaría dispuesto a trabajar?

Choose Applicable:*

VA
NC
WV

Have you worked on a Natural Gas Pipeline before?*

Yes
No

Please check all skills you know you are capable of performing. If requested, please be prepared to verify with documentation that you can perform the skills checked.

Favor marque las habilidades que usted pude desempeñar. También, si se requiere, esté preparado para proveer verificación acerca de la habilidad que marcó con documentación necesaria.

Pipeline Experience / Experiencia en construction de lineas de gas**

Clearing Crew (Chain Saw)
Environmental Crew
Grading Crew
Ditch Crew
Skid Crew
Stringing Crew
Bending Crew
Sandblasting Crew
Coating Crew
Lowering In & Tie-In Crew
Clean Up & Restoration Crew
Traffic Control & Flagging
First Aid / CPR Certified
OSHA 10 Certified
No Pipeline Experience (Willing to learn)

Are you currently employed?*

Yes
No

If so, please list the company name:

Additional Skills / Habilidades**

Asbestos Certified
Asphalt Paving
Backfilling / Compacting
Blueprints
Brick Paver
Bridge Course Worker
Caisson Worker
Carpenter
Certified Flagger
Confined Space Certification
Crane Signaling
CDL Class A License
CDL Class B License
Chuck Tender
Concrete Laborer
Concrete Finisher
Directional Drilling / Boring
Rough Grade Dozer Operator
Fine Grade Dozer Operator
Epoxy
Excavation
First Aid / CPR Certified
Form Setter
Foreman
Heavy Highway Form Carpenter
Heavy Highway Laborer
Grout man
Jack Hammer
Laborer
Landscaper
Land Surveyor
M.O.T. Cert. / Exp.
Mason Tender
OHSA 10 Certified
OHSA 30 Certified
OHSA 40 HAZWOPER
OSHA 8hr HAZWOPER Refresher
Pipe Layer
Rodman - Rebar
Rigging and Signaling
Scaffolding
Shoring
Sandblasting
General Laborer
None of the experience listed above (Willing to learn)

Prior Employers/Empleadores Anteriores

3 Companies you worked for? 3 Compañías para las que ha trabajado?*

Have you applied with us before? Usted ha aplicado aqui antes?

Yes/Si
No/No

How did you hear about us?

Job posting on the internet? Please list website (if applicable):

Please list name of your recruiter (if applicable):

Larry Harris
Alix Khani
Edsel McDonald
Felipe Lopez
Adam Broderson
Chef Johnson
Johnika Avent-Alford

Friend/Word of Mouth (if applicable):

Yes
No

How did you hear about us (if none of the above apply)?

CAPTCHA Code:*

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