Gms Mine Application Form – Fill Out and Use This PDF

**Please provide a copy of all mining certification cards, training slips and a valid drivers’ license**

Have you ever been		NO	If yes,
convicted of a	YES
			explain:
felony?

Are you at least 18 years old?

YES

NO

How will you get to

work:

Driver’s License Number

State

Issued

Who should be contacted if you are involved in an emergency?

Contact Name:

___________________________________________________

Relationship to you:

________________________________________________

Address: ________________________________________________________

City/State/Zip:

____________________________________________________

Daytime phone: _______________________Evening phone: _________________

EDUCATION

High School:

Address:

To

Did you

YES

NO

Degree

graduate?

College:

Address:

To

Did you

YES

NO

Degree

graduate?

PREVIOUS EMPLOYMENT

Company								Phone	(	)
Address								Supervisor
Job Title						Starting Salary		$	Ending Salary		$
Work Performed
From		To			Reason for
					Leaving
May we contact your previous supervisor for a reference?										YES	NO
Company								Phone	(	)
Address								Supervisor
Job Title						Starting Salary		$	Ending Salary		$
Work Performed
From		To			Reason for
					Leaving
May we contact your previous supervisor for a reference?										YES	NO
Company								Phone	(	)
Address								Supervisor
Job Title						Starting Salary		$	Ending Salary		$
Work Performed
From		To			Reason for
					Leaving

PLEASE USE THIS AREA TO LIST ANY SKILLS THAT MAY BE USEFUL FOR THE JOB YOU ARE SEEKING AND HOW

MANY YEARS OF EXPERIENCE YOU HAVE.

MILITARY SERVICE

Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

REFERENCES

Please list three people who would be willing to provide a reference for you.

Full Name	Relationship
Company	Phone	(	)
Address
Full Name	Relationship
Company	Phone	(	)
Address
Full Name	Relationship
Company	Phone	(	)
Address

DISCLAIMER AND SIGNATURE

Icer tify t h at th e in for m ation pr ovid ed on th is Application is tr u th fu l an d accu r ate. I u n d er stan d th at pr ovid in g false or m islead in g in for m ation will be th e basis for r ejection of m y Ap plication , or if em ploym en t com m en ces im m ed iate

ter m in ation .

Iau th or ize GMS Min e Rep air & Ma in ten an ce. to con ta ct for m er em ployer s a n d ed u cation al or gan ization s r egar d in g m y em ploym en t an d ed u cation . I au th or ize m y for m er em ployer s an d ed u cation al or gan ization s to fu lly an d fr eely

com m u n icate in for m at ion r egar d in g m y pr eviou s em ploym en t, atten d an ce, an d gr ad es. I au t h or ize t h ose per son s

d esign ated as r efer en ces to fu lly an d fr eely com m u n ica te in for m at ion r egar d in g m y pr eviou s em ploym en t an d ed u cation .

Iau th or ize GMS Min e Rep air & Ma in ten an ce. to con d u ct backgr ou n d ch ecks. An y in for m at ion will be h eld con fid en tial with GMS Min e Repa ir & Main t en an ce.

If an em ploym en t r elation sh ip is cr eated , I u n d er stan d th at u n less I a m offer ed a specific wr itten con tr act of em ploym en t sign ed on beh alf of t h e or ga n ization by its H u m a n Resou r ces Man ager , t h e em ploym en t r elat ion sh ip will be en tir ely volu n tar y in n atu r e. In oth er wor d s, wit h ap pr opr iate n otice, I will h ave th e fu ll a n d com plete d iscr etion to en d th e

em ploym en t r elation sh ip wh en I ch oose a n d for r eason s of m y ch oice. Sim ilar ly, m y em ployer wou ld h ave th e sam e r igh t . Mor eover , n o a gen t, r epr esen tative, or em ployee of GMS Min e Repair & Main ten an ce. except in a sp ecific wr itten con tr act of em ploym en t sign ed on beh alf of th e or gan ization by its H u m an Resou r ces Man a ger , h as th e power to alter or var y th e volu n tar y n atu r e of th e em ploym en t r elation sh ip .

IH AVE CAR EFU LLY R EAD TH E AB OVE CER TIFICATION AN D I U N D ER S TAN D AN D AGR EE TO ITS TER M S :