Application Test

Application for Employment

Cardinal Services, LLC is an equal opportunity employer. The Company's policy is not to discriminate against any applicant or employee based on race, color, sex, age, disability, religion, national origin, military or veteran status, or any other basis protected by applicable law. All newly hired employees of the Company are subject to an introductory period of ninety (90) days from the date of hire. The applicant understands that the satisfactory completion of this evaluation period in no way constitutes an obligation by the Company to continue his/her employment and that all employees are subject to termination with or without cause as determined solely by the Company in its best interest. This application is considered active for sixty (60) days.

Type (please select one):

GL
PHMSA
FMCSA
USCG

How did you hear of this opening?*

If other, please explain

Personal Information

Email*

Phone*

Legal Name*

First Middle Last Suffix

Have you ever used any other name(s) which is (are) necessary for us to verify your employment or educational record?*

Yes
No

If yes, what name(s):*

Present Address*

Street Address Address Line 2 City State ZIP Code

Please provide your addresses for the last 3 years

Former Address

Street Address Address Line 2 City State ZIP Code

Former Address

Street Address Address Line 2 City State ZIP Code

Driver's License Number*

State*

Expiration Date*

Class/Endorsements (If Applicable)*

Employment Information

Position Applied For:*

Date Available*

Minimum pay desired:*

Per*

Have you ever been employed by or applied for a position with Cardinal Slickline, Cardinal Coil Tubing, Vesco Rental & Pressure Control?*

Yes
No

If so, what position?*

Dates of Employment: Start Date*

Dates of Employment: End Date*

Are you under any type of agreement that would prevent you from performing the job for which you are applying or for which you are being considered, such as a non-competition, non-disclosure, or non-solicitation agreement?*

Yes
No

Do you have any relatives employed by this Company?*

Yes
No

Name/Relationship*

Location*

In case of emergency notify:*

First Last

Phone*

Education

Name of High School*

Location of High School*

Did you graduate?*

Yes
No

If no, did you obtain a GED?*

Yes
No

College:

Did you graduate?

Yes
No

Trade, Business, Military, or Tech School

Did you graduate?

Yes
No

Personal References (Not related to you)

References*

Name	Relationship	Occupation	Years Known	Phone

Employment History

Give a complete record of all employment, including military, and reasons for periods of unemployment during the past 10-years. If you have been self-employed, list up to 5 of your major clients. List employers in reverse order starting with the most recent. Add another sheet if necessary. No "see resume" responses will be accepted.

Regulated/CDL - Applicants who will drive a regulated vehicle shall provide (10) years' information on those employers for whom the applicant operated such vehicle.

Are you employed now?*

Yes
No

May we contact your current employer?*

Yes
No

Employer Information #1

Company Name

Position Held

Starting Date

Ending Date

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Contact Person

Select the reason for leaving

Comment

Was position subject to FMCSA, FAA, USCG and/or PHMSA regulation?

Yes
No

Was position regulated by Federal or State drug and alcohol testing requirements?

Yes
No

Employer Information #2

Company Name

Position Held

Starting Date

Ending Date

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Contact Person

Select the reason for leaving

Comment

Was position subject to FMCSA, FAA, USCG and/or PHMSA regulation?

Yes
No

Was position regulated by Federal or State drug and alcohol testing requirements?

Yes
No

Employer Information #3

Company Name

Position Held

Starting Date

Ending Date

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Contact Person

Select the reason for leaving

Comment

Was position subject to FMCSA, FAA, USCG and/or PHMSA regulation?

Yes
No

Was position regulated by Federal or State drug and alcohol testing requirements?

Yes
No

Employer Information #4

Company Name

Position Held

Starting Date

Ending Date

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Contact Person

Select the reason for leaving

Comment

Was position subject to FMCSA, FAA, USCG and/or PHMSA regulation?

Yes
No

Was position regulated by Federal or State drug and alcohol testing requirements?

Yes
No

Employer Information #5

Company Name

Position Held

Starting Date

Ending Date

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Contact Person

Select the reason for leaving

Comment

Was position subject to FMCSA, FAA, USCG and/or PHMSA regulation?

Yes
No

Was position regulated by Federal or State drug and alcohol testing requirements?

Yes
No

Job Specific Training

Please select all that apply*

If other, please state:*

Do you currently possess a Transportation Worker Identification Credential (TWIC)?*

Yes
No

If yes, Card #*

Expiration Date*

Do you have a legal right to work in the United States?*

Yes
No

Did you serve in the U.S. Armed Forces?*

Yes
No

If Yes, please fill out below:

(Copy of DD214 is required)

Date of Entry*

Date of Discharge*

Branch*

Rank at Entry*

Highest Rank Attained*

Rank at Discharge*

Overseas Service*

Yes
No

If yes, how long?

Description of Duties*

List any special training that you received*

Please Review the Statements Below

Have you ever been convicted or adjudicated of a crime (California applicants see below)?*

Yes
No

Are you currently under any investigation or pending charge?*

Yes
No

Are you currently awaiting trial for any criminal offense?*

Yes
No

Have you ever initiated an act of violence in the workplace?*

Yes
No

Have you ever been sanctioned or had your driver's license suspended or revoked?*

Yes
No

California applicants: Do not identify convictions under California Health & Safety Code 11357(b) or (c), 11360 (b) (formerly subdivision (c) of section 11360), 11364, 11365, or 11550 related to marijuana offenses that occurred two or more years before the instant application. Also, do not identify any conviction for which the record has been judicially ordered sealed, expunged, statutorily eradicated, or any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed.

APPLICANT'S STATEMENT AND ACKNOWLEDGEMENT*

I give my consent.

1. I certify that this application was completed by me and that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge.
2. I understand that any misrepresentation or omission of facts called for on this application or during the application process may result in termination of the application process or my dismissal from employment at any time regardless of when the false answer or omission is discovered.
3. I authorize the Company to conduct any necessary investigations or inquiries regarding my background investigation. I hereby release all parties from any liability in connection with the provision and use of such information.
4. I understand that if offered employment, I am to abide by all rules and regulations of the Company.
5. I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause.
6. I understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by the Company.
7. I understand that the Company may share the information contained in this application with other Company employees for employment and administrative purposes and hereby consent to such transfer.
8. I consent to all of the following pre-employment processes, which are required by the Company and I further understand that the offer of employment is contingent upon my successfully completing all of pre-employment testing:
a. Motor Vehicle Report (MVR) (review of past driving record)
b. Drug screen (DOT and Non-DOT applicants)
c. Previous Employer Drug and Alcohol History (DOT applicants, 49 CFR 382.413)
d. Physical Examination and Functional Capacity Evaluation (consistent with federal and state law)
e. Background Check
9. I agree and understand that this application for employment in no way obligates the Company to employ me.

Name*

First Last

Date Signed*

Applicant Signature*

Have you completed the Predictive Index Behavioral Assessment?*

Yes
No

If you have not completed the Predictive Index Behavioral Assessment, please click the link here and complete the assessment. The assessment will open in a new tab, once finished please return to this tab and submit your application.

Application Test

Application for Employment

Personal Information

Please provide your addresses for the last 3 years

Employment Information

Education

Personal References (Not related to you)

Employment History

Employer Information #1

Employer Information #2

Employer Information #3

Employer Information #4

Employer Information #5

Job Specific Training

If Yes, please fill out below:

Please Review the Statements Below

Info

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