Downstream

PERSONAL INFORMATION Complete all applicable information

Name(Full - Last, First, MI):	Email Address:
Phone Number(area code first)	Cell Phone
Position(s) applied for (separate by commas):	Check all that you are willing to work: Full Time Part Time Overtime Temporary Weekends Evenings
Street Address
City	State	Zip
Are you legally authorized to work in the United States?	When could you start employment?
Have you previously been employed by our company?
Where?	When?
Have you ever pled "guilty" or "no contest" to, or been convicted of a crime? (an affirmative answer does not necessarily disqualify you for employment)? When? Charge?

VOLUNTARY SELF IDENTIFICATION

We are an Equal Opportunity/Affirmative Action employer and voluntarily comply with the laws and regulations related to employment and the advancement of employment opportunities for qualified disabled persons, disabled veterans, Vietnam-era veterans, women and members of minority groups. Any information you provide is: Voluntary Confidential Separate from application This information is used for government reporting and Affirmative Action record keeping only. Refusal to provide this information will not subject you to adverse treatment.
Gender:	Diversity:
Are you a Veteran:	Military Era:	Are you Disabled:	Last 4 digits of Social Security:
Federal Government Definitions of Affirmative Action Categories Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.

EMPLOYMENT HISTORY (List below last four employers, starting with the most recent one first))

Position:	Name of Company:	From (Mo/Yr)	TO (Mo/Yr)
Street Address:
City	State	Zip
Duties:		Reason For Leaving:

Sarting Wage/ Salary	Final Wage/Salary	Bonus	Commission
Name of Supervisor	Title and Department of Sup.	Phone Number of Supervisor	May we contact your supervisor? -

Position:	Name of Company:	From (Mo/Yr)	TO (Mo/Yr)
Street Address:
City	State	Zip
Duties:		Reason For Leaving:

Sarting Wage/ Salary	Final Wage/Salary	Bonus	Commission
Name of Supervisor	Title and Department of Sup.	Phone Number of Supervisor	May we contact your supervisor? -

Position:	Name of Company:	From (Mo/Yr)	TO (Mo/Yr)
Street Address:
City	State	Zip
Duties:		Reason For Leaving:

Sarting Wage/ Salary	Final Wage/Salary	Bonus	Commission
Name of Supervisor	Title and Department of Sup.	Phone Number of Supervisor	May we contact your supervisor? -

Position:	Name of Company:	From (Mo/Yr)	TO (Mo/Yr)
Street Address:
City	State	Zip
Duties:		Reason For Leaving:

Sarting Wage/ Salary	Final Wage/Salary	Bonus	Commission
Name of Supervisor	Title and Department of Sup.	Phone Number of Supervisor	May we contact your supervisor? -

Add up to 4 employers

EDUCATION INFORMATION

High School or GED	City	State	Year	Degree	Subjects Studied
College	City	State	Year	Degree	Major	GPA
Vocational	City	State	Year	Degree	Major	GPA
Other	City	State	Year	Degree	Major	GPA

REFERENCES

List any references other than supervisors listed under past employment.
NAME	PHONE	YEARS KNOWN	CAPACITY OF RELATIONSHIP
1.
2.
3.

SPECIALIZED CERTIFICATION/TRAINING

List any related certifications, licenses, skills, and/or training.

In what computer software programs are you proficient? Name the package(s):

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY

In consideration of my employment, I agree to conform to the policies and procedures of the company. I understand that in accepting this application, the company is in no way obligated to provide me with employment and that I am not obligated to accept employment if offered. Furthermore, if employed, I understand that I am employed at will and that my employment and compensation can be terminated with or without cause, and with or without notice at any time.

I authorize Integrated Service Company LLC and its divisions to contact, obtain and verify the accuracy of the information provided in this application from previous employers, educational institutions, and references. Furthermore, I release from liability Integrated Service Company LLC and its divisions any liability from seeking and using such information to make employment decisions and all other persons and organizations from providing such information.

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any falsified statements on this application or omission of fact on either this application or during the pre-employment process may result in my application being rejected, or, if I am hired, in my employment being terminated.

I understand that if hired, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to provide such within the required time shall result in termination of employment.

I understand that any offer of employment is conditional on the completion of pre-employment tests and documentation. I will, upon request, sign all necessary consent forms. All applicants are subject to a pre-employment drug screening.