What is the best time to contact you at your preferred telephone number?
Are you at least 18 years old? If you are under 18, you may need to supply the company with a work permit or limit your hours to those permitted by law.
Yes |
No
Have you ever filled out an application with us before?
Yes |
No
If yes, give date:
example: 10/16/2005
Have you ever been employed with us before?
Yes |
No
If yes, give dates:
example: 1999-2001
Are you currently employed?
Yes |
No
May we contact your current employer?
Yes |
No
Are you legally eligible for employment in the U.S.A? If you are offered and accept a position, you will be required, in accordance with United States law,
to provide proof of authority to work in the United States and complete Form I-9. Employment will
be contingent on providing such proof.
Yes |
No
PART II: Employment Interest
Date available for work:
What is your desired salary range?
Indicate when you are available to work:
Full-Time
Part-Time
Temporary
Evenings
Weekends
Are you currently on "lay-off" status and subject to recall?
Yes |
No
Can you travel if a job requires it?
Yes |
No
Have you ever been convicted of or pleaded guilty or no contest to a criminal offense
which has not been expunged from your record? A yes answer will not necessarily disqualify an applicant from employment.
Yes |
No
If yes, please explain:
Have you ever been terminated or asked to resign from any prior employment?
Yes |
No
Have you signed an agreement with another employer that might preclude you from
working for Chesapeake or have a bearing on your employment with Chesapeake, such as a non-disclosure or
non-compete agreement?
Yes |
No
If yes, please explain:
PART III: Educational Background
High School (please list most recent if attended more than one)
Name of School and Location (City & State)
Course of Study
No. of Years Completed
Diploma or Degree Granted
Undergraduate College
Name of School and Location (City & State)
Course of Study
No. of Years Completed
Diploma or Degree Granted
Graduate Professional
Name of School and Location (City & State)
Course of Study
No. of Years Completed
Diploma or Degree Granted
Other (Specify)
Name of School and Location (City & State)
Course of Study
No. of Years Completed
Diploma or Degree Granted
Describe any special qualifications, skills, training, apprenticeship, or experience that you
believe are relevant to the position being applied for or which could be beneficial to the company: You may exclude memberships or information which would reveal gender, race, religion, national orgin,
age, ancestry, disability or other protected characteristic or status.
List job-related professional, trade, or other business organizations to which you belong and
offices held: You may exclude memberships or information which would reveal gender, race, religion, national orgin,
age, ancestry, disability or other protected characteristic or status.
PART IV: Employment Experience
Start with your presetn job, or your most recent job if you are not currently exmployed.
Job 1
Company Name, Address & Telephone Number
Dates Employed
From: To:
Rate of Pay
Start: $ Final: $
Type of work Performed
Job Title
Name of Supervisor
Where there any disciplinary problems during your employment?
Yes |
No
Reason for Leaving
Job 2
Company Name, Address & Telephone Number
Dates Employed
From: To:
Rate of Pay
Start: $ Final: $
Type of work Performed
Job Title
Name of Supervisor
Where there any disciplinary problems during your employment?
Yes |
No
Reason for Leaving
Job 3
Company Name, Address & Telephone Number
Dates Employed
From: To:
Rate of Pay
Start: $ Final: $
Type of work Performed
Job Title
Name of Supervisor
Where there any disciplinary problems during your employment?
Yes |
No
Reason for Leaving
Job 4
Company Name, Address & Telephone Number
Dates Employed
From: To:
Rate of Pay
Start: $ Final: $
Type of work Performed
Job Title
Name of Supervisor
Where there any disciplinary problems during your employment?
Yes |
No
Reason for Leaving
Job 5
Company Name, Address & Telephone Number
Dates Employed
From: To:
Rate of Pay
Start: $ Final: $
Type of work Performed
Job Title
Name of Supervisor
Where there any disciplinary problems during your employment?
Yes |
No
Reason for Leaving
Job 6
Company Name, Address & Telephone Number
Dates Employed
From: To:
Rate of Pay
Start: $ Final: $
Type of work Performed
Job Title
Name of Supervisor
Where there any disciplinary problems during your employment?
Yes |
No
Reason for Leaving
State any additional information you feel may be helpful to us in considering your application:
PART V: References
Please list two professional and one personal reference.
Do not list relatives or current/former employees. List daytime phone numbers for each reference.
Reference 1
Name
Reference Type
Capacity they know you as?
Phone #
Reference 2
Name
Reference Type
Capacity they know you as?
Phone #
Reference 3
Name
Reference Type
Capacity they know you as?
Phone #
PART VI: Applicants Statement
I hereby certify that all information provided in this application is true and correct. I understand that any false or misleading statements contained in (or any omissions from) this application or my resume, provided in any interview(s) or otherwise made by me to Chesapeake Resources, Inc. (Chesapeake) will result in rejection of my application or, if Chesapeake has employed me, my discharge.
I authorize Chesapeake to investigate all information provided in this application and to secure desired information from any of my employers, references, and academic institutions. I hereby release all of those employers, references, academic institutions, and Chesapeake from any and all liability arising from their giving or receiving information about my employment, academic credentials, qualifications and/or suitability for employment with Chesapeake. I understand that any offer of employment is contingent upon a satisfactory evaluation of my employment history, background and references.
I understand Chesapeake is a drug-free workplace. I understand that an offer of employment may be conditioned on my taking and passing a test for the presence of illegal drugs and/or alcohol. I also understand that if I am employed by Chesapeake, Chesapeake may require that I be tested for illegal drugs and/or alcohol at any time.
If I am employed by Chesapeake, I will comply with all rules, regulations and policies of Chesapeake.
I understand that nothing in this application, in Chesapeake's policy statements or personnel guidelines (whether in a policy manual or elsewhere and whether written or oral), or in my communications with any Chesapeake employee is intended to create any employment or other contract between Chesapeake and me. I further understand that Chesapeake has and reserves the right to modify its policies at any time with or without giving me any notice of such changes.
I understand that if an employment relationship is established, it is an "at-will" relationship, meaning that I have the right to terminate my employment at any time for any or no reason, and Chesapeake also has the right to terminate my employment at any time for any or no reason. I further understand that, although other terms and conditions of employment may change, this at-will employment relationship will remain in effect throughout employment with Chesapeake unless it is specifically modified by an express written employment agreement for a specified term executed by the President of Chesapeake and me; this at-will relationship may not be modified by any oral or implied promises or agreements.
I understand that this application is only valid for the position applied for at present and that Chesapeake is not obligated to retain or consider this application for any other current or future openings.
I hereby acknowledge that I have read and fully understand all of the above statements.
Accept |
Decline
Initials
PART VII: MARYLAND LIE DETECTOR NOTICE
UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. ANY EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
I hereby acknowledge that I have read and fully understand the above Maryland Lie Detector Notice.
Accept |
Decline
