Employment Application

Thank you for your interest in working for Vulcan Precision Linings. Click Here to download Employment Application. Fill it out and fax it to the number on the application. Or, complete the on-line application, below, then click Submit when it’s complete.

Position Applying For*
Name ( First, Middle, Last)*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Social Security Number (Optional)
Day-TIme Phone*
Evening Phone*
Other Phone
Are you eligible to work in the United States?*
- Yes
- No
Are you 18 years of age or older?*
- Yes
- No
If NO, what is your current age?
Are you currently employed?*
- Yes
- No
What is your current job title & department?
Have you ever been employed by VPL, or any rubber company?
- Yes
- No
Dates of employment & reason for leaving?
Are you related to any current VPL employee?*
- Yes
- No
Their name & their relationship to you?
If required for position, do you have a valid driver’s license?
- Yes
- No
State of issuance, license #, and expiration date:
How did you learn about this employment opportunity at Vulcan Precision Linings?
Education:
Education?
City/State
City State / Province / Region
Did you graduate?
- Yes
- No
Date of graduation
MM slash DD slash YYYY
# of years till you graduate?
Degree Received
Major
Another Education to add?
- Yes
- No
Education?
City/State
City State / Province / Region
Did you graduate?
- Yes
- No
Date of graduation
MM slash DD slash YYYY
# of years till you graduate?
Degree Received
Major
Another Education to add?
- Yes
- No
Education?
City/State
City State / Province / Region
Did you graduate?
- Yes
- No
Date of graduation
MM slash DD slash YYYY
# of years till you graduate?
Degree Received
Major
Other credentials/ licenses/ professional affiliations, etc., which are relevant to the job(s) for which you are applying.
LANGUAGE SKILLS:
Please list any languages you currently read, write or speak, other than English
MINE SITE CERTIFICATES:
Do you currently hold or have held?
MSHA
- Yes
- No
- Current?
Mine Site Training:
- Yes
- No
- Current?
Name of Company
Any other companies list here
High Security Clearance
- Yes
- No
- Current?
Explain
VETERAN INFORMATION:
(Most Recent)
Are you a Veteran?
- Yes
- No
- Choose not to answer
Branch of Service
Date of Entry
MM slash DD slash YYYY
Date of Discharge
MM slash DD slash YYYY
Type of Discharge
Current Reserve
- Yes
- No
SKILLS:
Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert)
WORK EXPERIENCE:
Please detail your work history for the past five years. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Attach additional sheets if necessary. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.”
PLEASE NOTE:
VPL reserves the right to contact all current and former employers for reference information.
Start Date
MM slash DD slash YYYY
Current Job?
- Yes
- No
End Date
MM slash DD slash YYYY
Type of work
- Full Time
- Part Time
Number of hours week
Title
Starting Salary
Final/Current Salary
Organizations Name
Organizations Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor's Name
First Last
Supervisor Title
Supervisor Phone
Other Reference's Name
First Last
Other Reference Title
Other Reference Phone
Contact my current references:
- At Any Time
- Only if I am a finalist candidate
Primary Duties
Reason For Leaving
Did you drive Commercial Motor Vehicle (CMV)?
- Yes
- No
Was a CDL License required?
- Yes
- No
Class
Were you subject to the Federal Motor Carrier safety Regulations during this period?
- Yes
- No
Were you subject to CFR part 40 controlled substance and alcohol testing during this period?
- Yes
- No
Add Another Employment
- Yes
- No
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type of work
- Full Time
- Part Time
Number of hours week
Title
Starting Salary
Final/Current Salary
Organizations Name
Organizations Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor's Name
First Last
Supervisor Title
Supervisor Phone
Other Reference's Name
First Last
Other Reference Title
Other Reference Phone
Contact my current references:
- At Any Time
- Only if I am a finalist candidate
Primary Duties
Reason For Leaving
Did you drive Commercial Motor Vehicle (CMV)?
- Yes
- No
Was a CDL License required?
- Yes
- No
Class
Were you subject to the Federal Motor Carrier safety Regulations during this period?
- Yes
- No
Were you subject to CFR part 40 controlled substance and alcohol testing during this period?
- Yes
- No
Add Another Employment
- Yes
- No
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Type of work
- Full Time
- Part Time
Number of hours week
Title
Starting Salary
Final/Current Salary
Organizations Name
Organizations Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor's Name
First Last
Supervisor Title
Supervisor Phone
Other Reference's Name
First Last
Other Reference Title
Other Reference Phone
Contact my current references:
- At Any Time
- Only if I am a finalist candidate
Primary Duties
Reason For Leaving
Did you drive Commercial Motor Vehicle (CMV)?
- Yes
- No
Was a CDL License required?
- Yes
- No
Class
Were you subject to the Federal Motor Carrier safety Regulations during this period?
- Yes
- No
Were you subject to CFR part 40 controlled substance and alcohol testing during this period?
- Yes
- No
The following questions are based on the possible work sites at which VPL works: VPL often works out of town at various customer sites. Some require criminal background checks and separate drug screening.
Are you eligible to work out of town?*
- Yes
- No
Explain
Have you ever been convicted of a Felony?*
- Yes
- No
Date:
MM slash DD slash YYYY
Are you currently on Probation or Parole?
- Yes
- No
Date of Completion:
MM slash DD slash YYYY
Additional Explanation As Required
The following questions relate to driving and company vehicles or commercial motor vehicles (CMV)
Accident Record for past 3 Years or more.
Do you have an accident on your record?
- Yes
- No
Date
MM slash DD slash YYYY
Nature of Accident
Fatalities
Injuries
Another Accident?
- Yes
- No
Date
MM slash DD slash YYYY
Nature of Accident
Fatalities
Injuries
Another Accident?
- Yes
- No
Date
MM slash DD slash YYYY
Nature of Accident
Fatalities
Injuries
Traffic Convictions or Forfeitures for the past 3 Years,
Traffic Convictions or Forfeitures?
- Yes
- No
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Anymore?
- Yes
- No
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Anymore?
- Yes
- No
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
- Yes
- No
Explain Giving Details.
Has any license, permit, or privilege ever been suspended or revoked?
- Yes
- No
Explain Giving Details.
DRIVING EXPERIENCE
Straight Truck with 20ft Trailers
- Yes
- No
Type of Equipment
Dates
Approx # of miles driven
Tractor and Semi-Trailer
- Yes
- No
Type of Equipment
Dates
Approx # of miles driven
Tractor and two trailers
- Yes
- No
Type of Equipment
Dates
Approx # of miles driven
Motor-coach- School Bus
- Yes
- No
Type of Equipment
Dates
Approx # of miles driven
Other
- Yes
- No
Type of Equipment
Dates
Approx # of miles driven
List states operated in the last five years
Show special courses of training that will help you as a driver:
Which Safe Driving Awards do you hold and from what?
Show any trucking, transportation, or other experience that may help in you work for this company.
Name
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Employment Application

Education:

LANGUAGE SKILLS:

MINE SITE CERTIFICATES:

VETERAN INFORMATION:

SKILLS:

WORK EXPERIENCE:

PLEASE NOTE:

DRIVING EXPERIENCE