Jobs – MES Mining

PERSONAL INFORMATION:

Your Full Name: *

E-mail Address: *

Current Address: *

Permanent Address (if different from above):

Phone #: *

Alternate Phone #:

Drivers License #:

Drivers License State:

POSITION INFORMATION:

Position Applying For: *

How did you hear about our firm?

Would you be able to work shift work?

YES
NO

Would you be able to travel for the job?

YES
NO

When would you be able to start?:

Desired Salary:

PRESENT OR MOST RECENT EMPLOYER:

Employer:

Employer Address:

Your Position:

Salary:

Duties:

Dates of Employment:

Supervisor Name:

Supervisor Title:

Supervisor Phone:

May we contact?

YES
NO

Reason(s) for leaving?

PRIOR EMPLOYER:

Employer:

Employer Address:

Your Position:

Salary:

Duties

Dates of Employment:

Supervisor Name:

Supervisor Title:

Supervisor Phone:

Reason(s) for leaving?

PRIOR EMPLOYER:

Employer:

Employer Address:

Your Position:

Salary:

Duties

Dates of Employment:

Supervisor Name:

Supervisor Title:

Supervisor Phone:

Reason(s) for leaving?

PRIOR EMPLOYER:

Employer:

Employer Address:

Your Position:

Salary:

Duties

Dates of Employment:

Supervisor Name:

Supervisor Title:

Supervisor Phone:

Reason(s) for leaving?

PRIOR EMPLOYER:

Employer:

Employer Address:

Your Position:

Salary:

Duties

Dates of Employment:

Supervisor Name:

Supervisor Title:

Supervisor Phone:

Reason(s) for leaving?

EDUCATION:

High School Name & Address

Did you Graduate?

YES
NO

If you did not graduate, did you receive your GED?

YES
NO
NOT APPLICABLE

Special honors or awards:

Technical or Vocational School & Address:

Did you Graduate?

YES
NO

Degree or Certification:

Specialty:

Special honors or awards:

College or University & Address

Did you Graduate?

YES
NO

Degree :

Additional Degree(s):

Major:

Special honors or awards:

Other Education:

SKILLS:
Please describe any experience, training or certifications you have in the following areas.

Mining Work:

Heavy Equipment Operations:

Equipment Maintenance and Repair:

Electrical Work:

Blasting or Explosives Work:

Welding and Fabrication:

Surveying:

Construction, Excavation, etc.:

Computer Skills:

Other skills, licenses or training you want us to know about:

MILITARY SERVICE:

Have you ever served in the U.S. Military?:

YES
NO

Branch of Service:

Rank at time of separation:

Served From/To:

Military Occupation:

LANGUAGES:

Languages other than English — Indicate competence level from 1 (low) to 5 (native fluency).
Language: Level 1-5: READ WRITE SPEAK

Language: Level 1-5: READ WRITE SPEAK

MINING:

Do you have one or more years of underground mining experience?: *

YES
NO

If no, have you completed a new miner MSHA training course?: *

YES
NO

ELIGIBILITY TO WORK IN THE U.S.

Are you a U.S. Citizen or otherwise authorized to work in the United States on an unrestricted basis?: *

YES
NO

ELIGIBILITY TO WORK WITH EXPLOSIVES

E-1. Are you a fugitive from justice?: *

YES
NO

E-2. Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant or narcotic drug, or any other controlled substance?: *

YES
NO

E-3. Have you ever been convicted in any court of a felony, or any other crime, for which the judge could have imprisoned you for more than one year, even if you received a shorter sentence, including probation?: *

YES
NO

E-4. Are you under indictment or information in any court for a felony, or any crime, for which the judge could imprison you for more than one year?: *

YES
NO

E-5. Have you ever been adjudicated mentally defective (which includes having been adjudicated incompetent to manage your own affairs) or have you ever been committed to a mental institution?: *

YES
NO

E-6. Have you ever been discharged from the Armed Forces under dishonorable conditions?: *

YES
NO

E-7. Have you ever renounced your United States citizenship?: *

YES
NO

E-8. Are you an alien in the United States, other than a lawful permanent resident?: *

YES
NO

If you answered yes to any of questions E-1 through E-8, have you applied for and received restoration of explosives privileges?: *

YES
NO
NOT APPLICABLE

AFFIDAVIT, CONSENT AND RELEASE – PLEASE READ CAREFULLY BEFORE SIGNING
I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment, if required. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I understand that this application, verbal statements by management, or subsequent employment does not create an express or implied contract of employment nor guarantee employment for any definite period of time. Only the manager of MES has the authority to enter into an agreement of employment for any specified period and such agreement must be in writing, signed by the manager and the employee. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without reason and with or without notice.

I have read, understand, and by my signature consent to these statements. *

I AGREE
I DO NOT AGREE

Please type your name: (Handwritten signature required only upon hiring)

Please type today’s date:

* Required