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helpdesk@iqsinc.net713-640-9484

12705 S. Kirkwood, Ste. 214 Stafford, TX 77477

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Industrial Quality Services, Inc.

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713-640-9484

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Employment Application

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Personal

Full Name (First + Middle + Last)*

Address*

Street Address City State ZIP Code

Date of Birth*

MM slash DD slash YYYY

Phone*

Email*

Date Available*

MM slash DD slash YYYY

Desired Salary*

Position Applied For

Are You Willing to Work Overtime?*

Can you travel if required by this position?*

Have you ever worked for this company?*

Yes

No

When?

Have you ever been convicted of a felony?*

Yes

No

List dates, offenses, and disposition.

Convictions are not an automatic disqualification from employment.

Can you travel if required by this position?*

Yes

No

How were you referred to our organization?*

Employee

Other Company

Agency

Self

Employment Service

Other

Name of Referral Source:

Education/U.S. Military Service

Where did you attend high school, trade school, and/or college? (Click the + button to add a new row)*

Please list ALL.

School Name & Address

Major

Years Completed

GPA

Degree/Diploma

Have you ever served in the U.S. Armed Services?

Yes

No

Other

US Military Duties and special training

Rank held at discharge

References

Please list 3 professional references.

Full Name

Relationship

Company

Phone

Address

Employment History

Include part time or summer work.

Company Name (Most Recent)

Address

Street Address City State ZIP Code

Phone

Dates Employed

From

To

Job Title

Supervisors Name & Title

Type of Business

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

No

Did you have another job before this one?*

Yes

No

Company Name (Second Most Recent)

Address

Street Address City State ZIP Code

Phone

Dates Employed

From

To

Job Title

Supervisors Name & Title

Type of Business

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

No

Would you like to list another previous job?

Yes

No

Company Name (Third Most Recent)

Address

Street Address City State ZIP Code

Phone

Dates Employed

From

To

Job Title

Supervisors Name & Title

Type of Business

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

No

Would you like to list a 4th job?

Yes

No

Company Name (Fourth Most Recent)

Address

Street Address City State ZIP Code

Phone

Dates Employed

From

To

Job Title

Supervisors Name & Title

Type of Business

Base Rate of Pay (Hour/Week/Month)

Start

End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes

No

Special Skills

Computer

Other

Type of machines operated

List other skills/equipment/language experience you acquired

List all other production skills or experience

Industrial Site Applicants Only

YWIC CARD:

Yes

No

TWICC CARD Expiration Date:

MM slash DD slash YYYY

123BASIC PLUS CARD:

Yes

No

123BASIC PLUS Expiration Date:

MM slash DD slash YYYY

Driver License:

Yes

No

Driver License Expiration Date:

MM slash DD slash YYYY

Acknowledgements & Signature

I acknowledge my answers are true and complete.*

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Yes

No

Signature*

STAFFORD, TX

Address:
12705 S. Kirkwood, Ste. 214
Stafford, TX 77477

Phone number:
713-640-9484

DESTREHAN, LA

Address:
100 Alpha Dr Suite 110
Destrehan, LA 70047

PORT ARTHUR, TX

Address:
2901 Turtle Creek Dr, Ste. 412
Port Arthur, TX 77642

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