Get a Quote | Single Source Systems Inc.

Personal

Full Name (First + Middle + Last)*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone*

Email*

Are you authorized to work lawfully in the U.S? (In compliance with federal law, all persons hired will be required to verify eligibility to work in the United States and to complete the required employment eligibility verification form upon hire.)*

Yes
No

Are you at least 18 years or older? (If no, you may be required to provide authorization to work and/or may not be eligible for certain hazardous occupations pursuant to federal and state laws)*

Yes
No

Employment Desired

Which Position(s) are you applying for?*

Click on a position title to view the job description.

# of years of experience*

Hourly Rate/Salary Desired*

Date You Can Start*

Do you have a valid Driver’s License?*

Yes
No

Do you have a Real ID (with a gold star in the top right corner)?*

Yes
No

Do you have your own transportation?*

Yes
No

Are you afraid of heights?*

Yes
No

Are you bilingual?*

Yes
No

Please specify which languages you are most proficient in or use most frequently.*

Referral Source

How did you hear about us?

Walk In
Referral
Advertisement

Who referred you?*

Do you have any relatives or friends who work for our company?*

Yes
No

Names of friends or relatives employed in this organization

Employment History

Have you ever been employed by this organization before?*

Yes
No

If yes, list job title, dates, and location of employment*

Are you currently employed?*

Yes
No

May we contact your most recent employer?*

Yes
No

If yes, why are you considering leaving?*

Have you ever been discharged or asked to resign from a job?*

Yes
No

If yes, please explain.*

Employment History Details

Please provide your last ten (10) years of employment history, including periods of unemployment and U.S. Military Service. Start with your most recent employer and work backwards in time.

Company Name (Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

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 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

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 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

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 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Base Rate of Pay (Hour/Week/Month)

Start	End

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Education

List your education history starting with highschool

Name	Number of Years	Subjects Studied/Major	Graduate or Degree

List any business or job related academic honors, achievements, extracurricular activities, or memberships in business or job related organizations.

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for?

Computer Skills (please describe)

Professional License and Membership

Type of License(s) Held

Other Professional Memberships (You may omit any that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other protected status)

References

List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)*

Name	Phone	Company	Job Title	Type of Relationship

Emergency Contacts

List 1-5 people we may contact in case of an emergency*

Name	Phone	Company	Job Title	Type of Relationship

Resume Upload (optional)

If you have a resume you'd like to attach, please do so here. This is not required.

Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf, Max. file size: 8 MB.

Would you like to add a cover letter?

Yes
No

Cover Letter (optional)

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.

Max. file size: 8 MB.

Acknowledgement

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 termination.

Digital Signature:*

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date

TRAVEL AGREEMENT

I understand that traveling out of town for work is a requirement at Single Source. The amount of travel out of town is determined by the work schedule. Out of town travel is any jobsite that it 100 miles or more away from Single Source Corporate Offices at 109 E Broadway St., Peculiar, MO 64078. When traveling out of town for work, a $25.00 a day per diem will be given to each employee from the foreman at the start of each day. Motel room is furnished by the Single Source and may be shared with another employee on the crew.

Digital Signature:*

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date*

REQUIRED PERSONAL PROTECTIVE EQUIPMENT

Please check each item indicating that you have these items and will wear all PPE daily to the job site.

Checklist

HARD HAT
SAFETY BOOTS
SAFETY GLASSES
SAFETY VEST
TOOL POUCH
TAPE MEASURE
SHARPIE

Digital Signature:*

Printing your First Name + Middle Initial + Last Name will act as your digital signature.

Date*