Employment

479-968-5416
bids@kirbyspec.com
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Employment Application

Kirby Specialties Corporation is an equal opportunity employer and a drug-free workplace. To be considered fo ra job at Kirby Specialties, you must complete the entire application form.

Personal Information

Last Name*

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First Name*

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Middle Name

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Street Address*

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City*

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State*

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Zip Code*

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Phone Number*

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Email Address*

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Are you 18 years or older?*

YesNo Invalid Input

If offered a position, would you submit to a medical examination (paid for by Kirby Specialties) to verify that you are capable of performing specific job duties related to the job in question?*

YesNo Invalid Input

I am aware that Kirby Specialties Corporation is a drug-free workplace and, as required by law, a copy of the drug-free workplace policy is available to me upon my asking.*

YesNo Invalid Input

This employer participates in e-verify: the employer will provide the Social Security Administration and the Dept. of Homeland Security with information from each new employee's I-9 to confirm work authorization.

Position Applied For*

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Date Available*

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Salary Range*

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Can you speak English?*

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Are you employed now?*

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If so, may we inquire of your present employer?

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How did you hear about us?*

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Is there anything that would prevent you from working long hours or weekends if required?*

YesNo Invalid Input

Is there anything that would prevent you from traveling out of town to work?*

YesNo Invalid Input

Is there anything that would prevent you from staying overnight if required?*

YesNo Invalid Input

Current drivers license?*

YesNo Invalid Input

Current CDL?*

YesNo Invalid Input

U.S. Military or Naval service

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Rank

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Presently in Guard or Reserves

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Construction Training or Special Skills

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Highest Education Level Completed*

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Degree Acquired

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Former Employers

List below your last three employers, starting with the last one first.

Employer 1

Employer Name*

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Employer Address*

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Start Date (mm/yy)*

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End Date (mm/yy)*

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Salary*

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Position Held*

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Reason for Leaving*

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Employer 2

Employer Name

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Employer Address

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Start Date (mm/yy)

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End Date (mm/yy)

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Salary

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Position Held

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Reason for Leaving

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Employer 3

Employer Name

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Employer Address

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Start Date (mm/yy)

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End Date (mm/yy)

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Salary

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Position Held

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Reason for Leaving

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Which of these jobs did you like best and why?

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What did you dislike about the job(s)?

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References

Give the names of three persons not related to you, whom you have known at least one year.

Reference 1

Name*

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Address/Business*

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Phone*

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Years Known*

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Reference 2

Name*

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Address/Business*

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Phone*

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Years Known*

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Reference 3

Name*

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Address/Business*

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Phone*

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Years Known*

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Have you been convicted of or pleaded no contest to a felony within the last 5 years?*

YesNo Invalid Input

Emergency Contact

Name*

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Address*

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Phone*

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“I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION WILL BE REJECTED. IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY’S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY’S OPTION. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT’S PRESIDENT, AND THEN ONLY IN WRITING AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.”

Signature*

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Date*

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Our services

Industrial Construction
Civil Construction
Fabrication
Design Build

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Our History

With over 50 years in the business we have seen and done it all. Find out more about our history here...

CONTACT KIRBY SPEC

2401 East 16th St Russellville, AR 72802
bids@kirbyspec.com
(479) 968-5416

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