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First Name *

Last Name *

Email Address *

Phone *

Present Address

City

State

Zip

Job Applied For *

Are you able to perform the essential duties of the job you have applied for with or without reasonable accommodation?

YesNo

Are you currently participating in a Work Release Program? *

YesNo

Have you ever worked for Cottrell? *

YesNo

Do you want to work full or part-time? *

Full TimePart Time

What date are you available to start work? *

What shifts are you available to work? *

1st2nd3rdRotating

Education - please check all schooling you attended.

High SchoolCollegeTrade SchoolPost Graduate

What rate of pay do you expect? *

Are you 18 or older? *

YesNo

Why you? Briefly list any experience, skills or qualifications you have that would make you a good fit with the company.

If you have references we may contact, please indicate them here with a way to reach them.

If you are in this country on a visa, is it current?

YesNo

If you have a work visa, when does it expire?

Please upload your work history.

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I certify that the answers given here are true and complete to the best of my knowledge. I authorize the investigation of all statements contained in this application. I also authorize release of all medical records and information in connection with my physical condition past or present and my ability to perform the essential functions of the job with or without reasonable accomodation. If offered employment I understand I may be required to undergo a physical examination and submit to a drug and alcohol test. I may also be asked to submit to drug and alcohol testing throughout my employment. I understand that false, misleading or ommision of information given in my application or interview may result in discharge. I understand that I am required to abide by the rules and regulations of the employer. I authorize the schools, employers and referees noted in this application to submit to Cottrell Inc. any relevant information that may be required and I further release any and all parties providing information from any and all liability or claims for damages that may result from this disclosure. I understand that this application is not an offer of employment and does not in any way guarantee that I will get a job. I also understand that if hired, the company may change the terms and conditions and that both Cottrell Inc. and I have the freedom to terminate such employment whenever either chooses to do so with or without cause and with or without notice. I understand that no representative of Cottrell Inc. has the authority to enter into any agreement of employment. This statement has been read in its entirety.

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