Employment Application

Dobbs Coating Systems, Inc.

1888 Mineral Wells Hwy, Weatherford, TX 76088

Phone: 817-341-17777

Fax: 817-341-1797
Applicant Information
Name*
First Middle Last
Today's Date*
MM slash DD slash YYYY
Address*
Street Address Address 2 (Optional) City State ZIP Code
Phone:*
Email:*
Date Available:*
MM slash DD slash YYYY
Position Applied for:*
Desired Wage:*
Are you currently employed?*
- Yes
- No
If so may we contact your current employer?*
- Yes
- No
Are you over the age of 18?*
- Yes
- No
Are you authorized to work in the U.S.?*
- Yes
- No
If hired, are you willing to take a physical*
- Yes
- No
If hired, are you willing to take a drug test?*
- Yes
- No
If hired, can you work on the weekends?*
- Yes
- No
If hired, Can you work overtime?*
- Yes
- No
If hired, do you have reliable transportation?*
- Yes
- No
If hired, are you willing to travel?*
- Yes
- No
If hired, can you work off of ladder?*
- Yes
- No
If hired can you work over 50’ up on scaffold?*
- Yes
- No
If hired, can you pass a background check*
- Yes
- No
If no, explain?
Do you have friends, relatives or acquaintances working for this Company?*
- Yes
- No
Name:
First Last
Have you ever worked for this company?*
- Yes
- No
If yes, when?
Have you ever been convicted of a felony?*
- Yes
- No
If yes, explain?

Education
High School:
Address:
Street Address City State ZIP Code
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Did you graduate?
- Yes
- No
College:
Address:
Street Address City State ZIP Code
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Did you graduate?
- Yes
- No
Degree:
Other:
Address:
Street Address City State ZIP Code
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Did you graduate?
- Yes
- No
Degree:
Special Skills:*

References
Please list three professional references.
Name:*
First Last
Relationship:*
Company:*
Phone:*
Address:
Street Address City State ZIP Code
Name:*
First Last
Relationship:*
Company:*
Phone:*
Address:
Street Address City State ZIP Code
Name:*
First Last
Relationship:*
Company:*
Phone:*
Address:
Street Address City State ZIP Code

Previous Employment
Current Employer
Company:*
Phone:*
Address:*
Street Address City State ZIP Code
Supervisor:*
First Last
Job Title:*
Starting Salary:*
Ending Salary:*
From:*
MM slash DD slash YYYY
To:*
MM slash DD slash YYYY
Reason for Leaving:*
May we contact your previous supervisor for a reference?*
- yes
- No
Company:
Phone:
Address:
Street Address City State ZIP Code
Supervisor:
First Last
Job Title:
Starting Salary:
Ending Salary:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Reason for Leaving:
May we contact your previous supervisor for a reference?
- yes
- No
Company:
Phone:
Address:
Street Address City State ZIP Code
Supervisor:
First Last
Job Title:
Starting Salary:
Ending Salary:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Reason for Leaving:
May we contact your previous supervisor for a reference?
- yes
- No

Military Service
Branch:
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:

Disclaimer and Signature
I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.
Initial:*
I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.
Initial:*
I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.

I understand that I am on a 90 Probationary period.
Initial:*
Applicant Signature:*
Date:*
MM slash DD slash YYYY

Dobbs Coating Systems has a policy prohibiting possessing, distributing, using, consuming, or being under the influence of alcohol or illegal and unauthorized drugs and other harmful substances in order to provide a safe and healthy work environment for the company’s employees, visitors, customers and other personnel.

I understand that I may be dropped from consideration for employment with Dobbs Coating Systems if the results of my urine drug screen indicate that I tested positive for the presence of illegal drugs.

I have read and understand Dobbs Coating Systems pre-employment drug screen requirements. I accept Dobbs Coating Systems conditions for consideration of employment and consent to the requirement of a urine drug screen as an indicator of my ability to perform work safely.

I agree in submitting to this medical test that I have authorized the agency of Dobbs Coatings System’s choosing to take blood, urine, breath, and any other samples for testing to determine the presence of controlled substances (drugs) and/or alcohol in my system. I further authorize this agency to give the results of this test to Dobbs Coating Systems.

I agree to hold Dobbs Coating Systems, its agents, directors, officers and employees harmless from any and all liability in connection with the testing for drugs and the use of the results as it pertains to my consideration for employment.

Finally, I am aware and agree to Dobbs Coating Systems policy in regards to their right to do random drug testing throughout my employment at their discretion.
Printed Name:*
Applicant's Signature:*
Date:*
MM slash DD slash YYYY

PRE-EMPLOYMENT PHYSICAL/DRUG TEST AND BACKGROUND CHECK ACKNOWLEDGEMENT

I understand that in order to be employed by Dobbs Coating Systems, Inc. I will have to pass a Pre-Employment: Background Check, Physical/Drug Test, Respirator fit test and Base Line Blood Lead;
Applicant Signature:*
Date:*
MM slash DD slash YYYY

PRE-EMPLOYMENT BACKGROUND CHECK CONCENT FOR DOBBS COATING SYSTEMS, INC.

I authorize Dobbs Coating Systems, Inc. and/or its agents to conduct a background investigation. I further authorize Dobbs Coating Systems, Inc. and/or its agent to request or receive any information including criminal, motor vehicle reports, past employment and/or references from any persons, or previous employers.

This information is CONFIDENTIAL and will not be released to anyone other than Dobbs Coating Systems, Inc. and/or its agents, General Contractors and City officials as required by contractual agreement to provide security clearance.
Applicant Name:*
First Middle Last
Alias Names Used:
First
Date of Birth:*
MM slash DD slash YYYY
SSN:

If left blank we will reach out to you.
Driver’s License #:

If left blank we will reach out to you.
State Issued:
Home Phone #:
Cell Phone #:*
Current Address:*
Street Address City State ZIP Code
Previous Address:
Street Address City State ZIP Code

I understand the purpose of this background check it to gain authorization to access projects, which require ‘Security’ clearance. I understand Dobbs Coating Systems, Inc. will keep this authorization on file for the duration of my employment with them and obtain background information at any time.

The above information on this form is true. I understand that if gained authorization at projects, the background check will become a part of my personnel file and that any misstatement of fact on this form may be caused for immediate dismissal.
Applicant Signature:*
Date*
MM slash DD slash YYYY
According to the Fair Credit Report Act, upon receiving a written request, Dobbs Coating Systems, Inc. 1888 mineral Wells Hwy, Weatherford, Texas 76088, will provide information regarding the nature and scope of the report, should it include information about your character, general reputation, personal characteristics or mode of living and a summary of your rights.

PHYSICAL & DRUG SCREEN CONCENT FOR DOBBS COATING SYSTEMS, INC.

I authorize Dobbs Coating Systems, Inc. and/or the facility of its choosing in order to help to determine my physical ability to perform the scope of work associated with the position I am applying for to perform a pre-employment physical, drug screening , baseline blood lead , respirator fit and if necessary a pulmonary function test.

This information is CONFIDENTIAL, and will not be released to anyone other than Dobbs Coating Systems, Inc.
Applicant Signature:*
Date*
MM slash DD slash YYYY

Pre-Employment Physical/Drug Test and Background Check Deduction

Dobbs Coating Systems, Inc. will pay for your Pre-Employment: Physical/Drug Test, Base Line Blood Lead, Respirator fit /PFT if necessary and Background Check; however, if hired, if you resign from the company within 90 days from your date of hire, you will be responsible for the reimbursement which will automatically be deducted from your final paycheck.

The current cost is $500.00

I have read the above statement and fully understand that I am solely responsible for the total cost as stated above should I resign from this company within 90 days from my date of hire.

I authorize Dobbs Coating Systems, Inc. to deduct the full amount of the current cost of the Pre-Employment: Physical/Drug Test, Respirator fit /PFT if necessary and Background Check from my final paycheck.
Applicant Signature:*
Date*
MM slash DD slash YYYY
PAYROLL DIRECT DEPOSIT INFORMATION****EFFECTIVE January 1, 2010

Dobbs Coating Systems, Inc. only issues Payroll via Direct Deposit. All employees must enroll in direct deposit and must obtain a means of direct deposit either through a bank account or through debit card options such as Ace Check Cashing. You will need to have a Direct Deposit form filled out and turned in before you will be able to receive a Payroll check. Payroll is set up to be in your bank on Friday mornings. Payroll Vouchers are mailed out weekly so that you will know how much was deposited and can verify your hours for your records

I understand that Dobbs Coating Systems does not issues payroll checks and the only way that I will be paid is thru Direct Deposit either thru a bank account or a pre-loaded card.
Applicant Signature:*
Date*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

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