First Name
Last Name
Nickname
Email
Address
Phone Number
Alternate Phone Number WorkCellOther
Job requirements are the following: (check all that you are able to do) Use of Spray equipmentRollerBrushUse of Man Lift/BoomPainting from ladders and Aerial PlatformsUse of ScaffoldingUse of Lulls
Available to Work Full-timePart-time
I understand that Goggans, LLC may work Monday through Sunday and travel out of town for a week at a time. Travel is by company vehicle. Hotel and per diem are paid by employer. (Your signature)
How did you learn about this company and position?
Job advertisement(identify publication or other media):
Employee referral(identify employee):
Other(please specify):
Do you have any of the following certifications: Check all that apply
10 Hour OSHA Safety Course/wallet cardLull/Forklift operator safety cardAny special coatings certificates
For each level of schooling below, please write the school name, the city and state where it is located, your major and minor subjects, and the degree or diploma you received.
High School
College 1
College 2
Graduate School
Business, Trade, or Other Schools
Starting with your current or most recent employer, please provide the following information about the last three companies for which you have worked.
Employer 1 (current or most recent)
Company Name
Dates Employed
Job Title(s) Held
Job Responsibilities
Name of Immediate Supervisor(s)
Employer 2
Employer 3
Please carefully read the statements below and initial each one to indicate that you understand and agree to the terms stated. Then sign this form at the bottom.
I certify that all information I have supplied on this form is correct to the best of my knowledge. I understand that omissions or providing deliberate misinformation will disqualify my application and, if hired, would serve as grounds for dismissal.
I give consent to GOGGANS, LLC to contact the employers listed on this form for my employment references. I authorize these individuals to provide truthful information regarding my employment and previous work experience. In doing so, I waive liability against the employers and individuals contacted as my references, provided the information they supply is honest, factual and given without malice.
Applicant’s Signature
Date
