Employment Application
 
 
Today's date
 
Date available to start
 
How did you hear about us?
 
 
Last Name
 
First Name
 
Middle Initial
 
Social Security Number
 
Street Address
 
City
 
State
 
Zip Code
 
Telephone Number
 
 
If hired, can you provide proof of US citizenship, or verification of your legal right to work in the United States?

Yes:
No:
   
 
If US a US citizen, please insert your alien regisrtation number

 
Are you at least 18 years of age?

Yes:
No:
   
  Educational Background  
 
Grade School (Highest completed)
 
High School (Highest completed)
 
College / Tech (Highest completed)
 
Grad School (Highest completed)
         
  Military Service      
 
Service Branch
 
Years Served
   
  Senesco Attendance Statement  
 

Senesco expects a high attendance rate of employees. Applicants should be aware of the following:

*Senesco's regular (full-time) work week is Monday through Thursday, 6:30 AM to 5:00 PM and Friday is 6:30 AM to 3:00 PM, for the first shift (mandatory 48 hour week) and 5:00 PM to 3:00 AM for the second shift. Hours will vary. Office hours 8:00 AM to 5:00 PM

*Saturday and Sunday are optional workdays, as required by the company.

*The Company reserves the right to modify the work week without notice.
 
Can you meet the required attendance of your position?

Yes:
No:
 
Will adequate and reliable transportation be available to you?

Yes:
No:
   
  Job Interest  
 
What position are you applying for?
 
Type of work preferred:
 
Expected Salary
 
Are you available to work all shifts?
 Yes:
No:
 
Preferred shift:
   
  Skills and Qualifications  
 

(Check all that apply)

 Blue Print Reading Brake Press Oper. CNC Plasma Oper.
    Forklift Oper. Oxy Fuel Cutting Pipe Fitter
    Rigger Ship Fitter Theodolites
   
    Crane Oper. Welder Computer Skills
    T/R Stick PC
    Overhead Fluxcore MAC
    Crawler Mig  
      Subarc  
   
  Computer Programs (Please List)

   
         
  Other Skills (Please List)

   
 
Do you know and understand the physical requirements of the position you are applying for?
 Yes:
No:
 
Do you know and understand the skill and training requirements of the position?
 Yes:
No:
 
Are you able to meet these requirements? (Note: employees will be subject to a physical review and/or exam.)
 Yes:
No:
   
  Employment History  
    Current or Most Current Position  
 
Employer name
 
Position held
 
Employer Address
 
Employed from: (Date)
 
Employed to: (Date)
 
May we contact this employer?
 Yes:
No:
 
Supervisor's name
 
Supervisor's phone number
 
Salary / Hourly rate
 
Average hours worked weekly
 
Reason for leaving
   
    Previous Position 1  
 
Employer name
 
Position held
 
Employer Address
 
Employed from: (Date)
 
Employed to: (Date)
 
May we contact this employer?
 Yes:
No:
 
Supervisor's name
 
Supervisor's phone number
 
Salary / Hourly rate
 
Average hours worked weekly
 
Reason for leaving
   
    Previous Position 2  
 
Employer name
 
Position held
 
Employer Address
 
Employed from: (Date)
 
Employed to: (Date)
 
May we contact this employer?
 Yes:
No:
 
Supervisor's name
 
Supervisor's phone number
 
Salary / Hourly rate
 
Average hours worked weekly
 
Reason for leaving
         
  Remarks

   
         
  Senesco statement of working conditions    
 

Compliance with company guidelines and policies

I understand that I will be hired on an introductory basis for a period of up to 3 months. My on-the-job traingin could last for up to 6 months, depending on my skill levels. I understand that my promotion and advancement in the company will be dependant on my continuing to learn new job skills and functions.

I understand that as an employee of Senesco I will be expected to comply with all company policies. The company will provide me with a guidance of work related procedures, standards, policies, and directions that conform to state and industry standards. These guidelines will be writen in English and provided to me by my supervisor. If necessary, an intrpreter will be available upon my request.

I understand that my failure to comply with company work and safety guidelines could cause injury to myself, to others, or to company equipment. I understand that my active, ongoing compliance with company guidelines and policies is a condition of my employment.
 
I have read and understand all of the above information

Yes:
No:
         
 

Job requirements and workplace conditions

I understand that as an employee of SENESCO I may be assigned to perform various tasks involving metal fabrication, product assembly, and support. I understand that I may be exposed to personal health risks normally associated with heavy manufacturing and assembly. Potential hazards could consist of welding arcs, fumes, grit, sparks, and metal particles.

I understand that I may work in open air or in buildings that are weather-protected and ventilated, but not heated or cooled except as required in specific work stations. Some jobs that I perform may require me to be near motor vehicles, railroad tracks, overhead and stationary cranes and forklifts. I understand that my work station may be located on the waterfront, and may require me to work on or over the water.

I understand that any of the following may be true: my work might require entry into confined and closed spaces which require physical agility. I may work under artificial lighting conditions. I may work at stations where I have to stand, crouch, and kneel for long periods of time. I may work with computers, hand tools, and powered tools that could cause stress to muscular and skeletal body parts or injury to my person.

I understand that my job could include lifting of weight of up to 50 pounds on a regular basis. On an occasional basis I may lift weights of up to 100 pounds. In the course of my duties I may be required to walk a combined distance of a mile or more a day. In order to access work areas, my job may include climbing and working on stairs, ladders, scaffolding or similar devices.

I understand that SENESCO is a heavy metal fabricator and that heavy equipment will be in use. This equipment may be located in permanent locations, or it may be mobile and moving throughout the facility. I understand that that such equipment poses its own hazard if operated carelessly or incorrectly. As a SENESCO employee I will not operate any equipment unless qualified to do so by the company, and then only in a safe, careful manner.
 
I have read and understand all of the above information

Yes:
No:
         
 

Safety equipment and clothing

SENESCO will install protective devices to reduce hazards potentially caused by welding arcs, fumes, grit, sparks, and metal particles. Protective devices may include screens, extractors, signs, covers, screens, etc. SENESCO will provide an initial outfit of safety equipment, at Company expense. I agree to maintain this equipment at my own expense.

Wearing personal safety equipment (PPE) such as hard hats, safety glasses and safety shoes are mandatory in the facility. Additional (PPE) such as breathing equipment, a fall protection harness, and life jackets may be required for specific tasks. Personal safety equipment will be supplied to me by SENESCO.

I understand that following company dress codes, safety procedures, policies, and guidelines is essential for my personal safety, the safety of my coworkers, and the preservation of company equipment.
 
I have read and understand all of the above information

Yes:
No: