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Employment Application

CUSTOM PUMP & CONTROLS, INC. Hereafter known as (CPC), is an Equal Opportunity Employer and does not discriminate against any individual in any phase of employment in accordance with the requirements of local, state, and federal law. In addition, CPC has adopted an Affirmative Action Program with the goal of ensuring equitable representation of qualified women, minorities, Vietnam Era and disabled veterans, and other disabled individuals, at all job levels.

Applicants may be subjected to testing for illegal drugs. In addition, applicants for certain positions who receive a conditional offer of employment must pass a medical examination prior to receiving a confirmed offer of employment.

This application will be considered active for 60 days. If you have not been employed within this period and are still interested in employment at CPC, please contact the office where you applied and request that your application be reactivated.

Name(Required)
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Address(Required)
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Previous Address (if less than 2 years at present)
Are you a citizen of the United States?(Required)
Are you authorized to work in the U.S.?(Required)
Have you ever worked for this company?(Required)
Have you ever been convicted of a crime involving dishonesty or violence?(Required)
Do you possess a valid driver's license?(Required)
Do you have any relatives employed by CPC?(Required)

EDUCATION

Address
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Did you graduate?
Address
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Did you graduate?
Address
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Did you graduate?

REFERENCES

Name(Required)
Address(Required)
Name(Required)
Address(Required)
Name(Required)
Address(Required)

THE FOLLOWING QUESTIONS ONLY APPLY IF THE POSITION YOU DESIRE REQUIRES DRIVING:

Are you licensed to drive a car?
Is your license valid in this state?

PREVIOUS EMPLOYMENT

Address(Required)
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May we contact your previous supervisor for a reference?(Required)
Address
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May we contact your previous supervisor for a reference?
Address
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May we contact your previous supervisor for a reference?

MILITARY SERVICE

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PLEASE READ THE FOLLOWING PARAGRAPH BEFORE SIGNING THIS APPLICATION

Consent(Required)
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